Facility Evaluation Report

On 4/26/2022, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Licensee/Administrator Socorro Telmo (Ann)

Visitor log-in/temperature check, masks, and disinfection station were observed upon entry. Facility has one

entrance/exit point. Hand sanitizer was readily available to residents and visitors. Hand washing and other

various Covid-19 related signs were observed in the common areas. Facility staff observed with facecoverings.

All pathways, entrances and exits were clear from obstructions. Fire extinguisher was serviced on 3/3/2022. LPA toured bedrooms with adequate furnishings. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. LPA observed a 30-day supply of PPE. LPA checked residents' medication and observed a 30-day supply. Laundry area was observed unlocked with laundry detergent, bleach, and cleaning supplies. Staff files were reviewed for good health. It was verified that there is at least one staff on duty who is CPR certified. LPA did not observe updated emergency contact information for Resident’s.

Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22,

LPA is requesting the following documents be submitted to the Fresno CCL office by 5/03/2022: Current copy

of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC

309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel

Report (LIC500), Register of Facility Clients/Residents for LIC9020.

An exit interview was conducted with Staff. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Report signed on-site by Administrator.