Facility Evaluation Report

Licensing Program Analyst (LPA) K.Kaur conducted an Annual Inspection on this date. LPA met with Administrator Nancy Montiano. LPA and Administrator began the tour at the front entrance/office of the facility.

Visitor log-in/temperature check, masks, and disinfection station was observed upon entry. Facility has one entrance/exit point. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing and other various Covid-19 related signs were observed in the common areas.

LPA observed a two-day supply of perishable food and seven-day supply of non-perishable food. Cleaning supplies were observed behind a locked door in storage. Personal protective equipment in a storage cabinet in garage. At 1:23 PM LPA observed the laundry room door to be unlocked with a bleach bottle under the sink. Staff records were reviewed for infection control training. LPA observed facility staff without masks. Resident’s files have updated emergency contact information.

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 1/24/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

Exit interview was conducted. Report signed on-site; printed copy of report provided with appeal rights.