Facility Evaluation Report

On 01/30/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Staff, stated the purpose of the visit and was allowed entry into the facility. Administrator arrived shortly after. LPA a toured he facility inside and out. on record is Amabelle Bernales, Certificate# 6018122735, Exp. 06/07/24.

LPA observed 3 residents in care at the time of visit. Facility is a 4 bedroom 2 bathroom home. Residents bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. Facility temperature was 71 degrees F.

Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 120 degrees F. Trash can with lid and hand washing postings were observed.

Medications were observed to be locked in a cabinet located in the kitchen. Cleaning supplies were observed to be locked in the laundry room. 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. Night lights were observed. Fire Extinguisher was observed with a service date of 05/26/23. First aid kit was observed and contained all required items.

LPA is requesting the following documents be submitted to the Fresno CCL office by 01/31/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC 610D) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond.

Exit interview conducted. No deficiencies cited. A copy of this report was discussed and provided to Administrator, Amabelle Bernales, whose signature on this form confirms receipt of this document.