Facility Evaluation Report

On 12/08/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA contacted Administrator via telephone. Administrator, Jose Cortez (AD), arrived a short time later. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. Upon entry to the facility, LPA observed a visitor temperature check / sign in. The facility has one central entrance and exit.

LPA conducted a facility tour with AD. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing signs observed in the resident bathrooms. Other various Covid-19 related signs were observed in the common areas.

LPA observed a two day supply of perishable foods and seven day supply of non-perishable foods. Cleaning supplies were observed behind a locked cabinet in the laundry room. LPA observed an adequate supply of PPE and cleaning supplies. LPA observed facility staff to be wearing facial coverings. Resident’s files have updated emergency contact information.

LPA is requesting the following documents be submitted to the Fresno CCL office by 12/22/2022: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond.

No deficiencies issued. An exit interview was conducted with AD. A copy of this report was discussed and provided to Administrator, Jose Cortez, whose signature on this form confirms receipt of this document.