Senior Care Records.

Facility Evaluation Report

Evergreen Home, Hanford08/26/2023Licence 167201075

Capacity6
Census2
Date signed09/06/2023 09:50:34 AM
The inspector’s account

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee, Zoria French Continual Administrators certificate expired March 26, 2023. There are currently 1 residents who reside at this home. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Fire extinguisher is not within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Toxins and cleaning supplies are locked and inaccessible.

LPA Hurt observed the facility fire extinguisher was purchased in 03/22 and was not serviced within the last year. LPA Hurt observed the facility has expired food in the kitchen cabinets.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610 the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Licensee Zoria French and copy of report left at facility

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction