Facility Evaluation Report

On 8/9/2022, Licensing Program Analyst (LPA) K. Kaur arrived unannounced to conduct an Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit, and was allowed entry by Administrator Jill Marmon and House Manager Johnny Bursiaga .

Facility staff were observed with face coverings. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Social distancing and cough etiquette postings observed in facility. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Fire extinguisher in Kitchen was last serviced on 12/15/2021 and was fully charged. A 2-day supply of perishable and 7-day supply of non-perishable food was observed. Cleaning supplies were observed behind a locked door in the kitchen. All resident’s room toured and observed to be adequately furnished and lit throughout. LPA toured bathrooms and observed Trash bins with lids and hand washing signs. LPA checked residents’ locked medication and observed a 30-Day supply kept locked in the office. 30-day supply of PPE and incontinence supplies kept in office.

A small sample of Staff records were reviewed for good health and infection control training. Residents’ records reviewed to have updated emergency contact information. No deficiencies were observed.

LPA is requesting the following documents be submitted to the Fresno CCL office by 8/16/2022: 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.

An exit interview was conducted with Administrator. Report signed on-site by Administrator and printed copy