Facility Evaluation Report

Licensing Program Analyst LPAs K.Kaur and S. Doucette conducted an Annual Inspection on this date.

LPA(s) were met by Administrator Cynthia Scott who did temperature screening and conducted a facility tour.

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. Hand washing and other various Covid-19 related signs were observed in the common areas.

LPAs observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning

supplies were observed in the kitchen locked cabinet under the sink. LPAs observed the following personal

protective equipment in a storage cabinet; gloves, masks, N95 masks. LPA observed all facility staff wearing masks. Resident’s files have updated emergency contact information.

Please submit the following forms/information to Fresno CCLD. Requested forms/ information: Current Copy

of Administrator’s Certificate, LIC308, LIC309, LIC400 (if applicable), LIC 500, LIC402 (If applicable), and

Plan LIC610D Emergency and Disaster. Exit interview was conducted and a copy of this report was provided