Facility Evaluation Report

On 8/30/22, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPA met with Administrator Cynthia Guerra and stated the purpose of the visit.

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

entrance/exit point. Facility staff observed with facial coverings. Facility appeared clean with no obstruction or

fire clearance issues. Hand sanitizer was readily available to residents and visitors. Hand washing and other

various Covid-19 related signs were observed in the common areas.

Sharp items and cleaning supplies are kept locked in the living room cabinets. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Fire extinguisher in the hallway was last serviced on 06/03/2022 and was fully charged. PPE supplies are kept in the living room cabinets. Three trash cans observed with lids, rest without. Hand washing posters were observed in the bathrooms by the sink. Staff records were reviewed for infection control training. Resident’s files have updated emergency contact information.

LPA is requesting the following documents be submitted to the Fresno CCL office by 9/06/2022: 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 (LIC610E),

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

An exit interview was conducted with Licensee. Report signed on-site and printed copy provided.