Facility Evaluation Report

On 09/27/25, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Direct Support Personnel (DSP), stated the purpose of the visit and was allowed entry into the facility. Administrator was contacted and was available at the time of visit. DSP provided a tour of the facility inside and out.

LPA observed 2 residents in care at the time of visit. Facility is a 3 bedroom 2 bathroom home. Resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction. A supply of linens and personal supplies for residents were observed in the hallway. Facility temperature was 73 degrees F. Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 113.9 degrees F.

Medications were observed to be locked medication cabinet located in the laundry room. Cleaning supplies were observed to be locked closet next to the entry way. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. There are no residents with Restricted Health conditions in the facility.

Carbon monoxide and smoke detectors were tested and observed to be operational Fire Extinguisher was observed with a service date of 03/05/2025 . First aid kit was observed and contained all required items. A working phone line and internet device was observed to be available for residents in care. A sample of resident and staff files were reviewed and observed to have the required documents. Fire and disaster drill was observed 04/17/25

The exterior tour of back yard was conducted and found to be free from debris. A covered outdoor seating area was observed for residents in care. Side gate was self-closing and self-latching. The following documents are requested and submitted to Fresno CCL by: 10/10/25:

LIC 308, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9020.

An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.