Facility Evaluation Report

On 11/15/2021, Licensing Program Analyst (LPA) Walton arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. Facility has one central entry and exit point. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. LPA met with Assistant Administrator, Lacey Jackson and Personal Care Coordinator, Rosa Storey.

Facility tour conducted. All pathways, entrances and exits were clear from obstructions. No fire clearance issues. LPA observed signs promoting hand-washing, social distancing, and cough/sneeze etiquette. Facility staff observed to be wearing facial coverings. LPA toured the facility kitchen. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. LPA observed a 30 day supply of PPE and cleaning supplies.

There are 3 shared bedrooms at the above facility. Beds observed to be at least 3 feet apart with head to toe orientation. Bathrooms observed to be stocked with paper towels and liquid soap. Hand-washing signs observed in resident bathrooms. LPA checked residents' medication and observed a 30 day supply. Resident and staff temperature checks are documented daily. Resident records have updated emergency contact information. Facility staff records reviewed for good health.

LPA is requesting the following documents be submitted to the Fresno CCL office by 11/29/2021: 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, Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

No deficiencies issued during this inspection. Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email and an electronic read receipt confirms receiving this document. Report signed on-site.