Facility Evaluation Report

On 08/05/25, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Adminstrator, stated the purpose of the visit and was allowed entry into the facility. Administrator on record is Cynthia Guerra #7034668735 and #6005722740.

LPA observed 1 resident 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 79 degrees F. Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 109.8 degrees F. Trash can with lid and hand washing postings were observed.

Medications were observed to be locked in a cabinet located in the entry way. Cleaning supplies were observed to be locked in a hall closet 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 in the hallways. Fire Extinguisher was observed with a service date of 06/14/25. First aid kit was observed and contained all required items. Internet devices and a working phone line were observed to be available for residents in care.

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. Quarterly Emergency Disaster Drill logs were observed for staff. LPA observed on the LIC 610D (Emergency Disaster Plan) with emergency numbers and evacuations locations was posted in the kitchen.

A sample of resident files were reviewed and observed to have update emergency contacts, Admission agreement, and current physician report/individual performance plans (IPP). Administrator file was also reviewed and observed to have current First Aid/CPR. Staff are fingerprinted clear and associated to the facility.

The following documents are requested and submitted to Fresno CCL by: 08/15/25:

LIC 308, LIC309 (If Applicable) LIC 400, LIC 402, LIC 500, LIC 610D, Copy of current Administrator certificate and Emergency and Disaster Plan. 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.