Facility Evaluation Report

On 6/1/2022, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct

an Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit, and was granted

entry to the facility by Licensee Andrea Duran and Mary Ellen Gurrola.

Visitor log-in/temperature check station was observed upon entry. Hand sanitizer was readily available to

residents and visitors. Facility has one entrance/exit point. Hand washing and other various Covid-19 related

signs were observed in the common areas. Facility staff were observed with mask covering.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway

obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout.

Fire extinguisher was observed with a purchase date of: 4/28/2022 in the kitchen. Chemicals and cleaning

supplies were locked in the office closet. A 2-day supply of perishable and 7-day supply of non-perishable

food was observed to be properly stored and labelled. Resident's Bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting. Linens and hygiene products were observed in the hallway closet.

LPA is requesting the following documents be submitted to the Fresno CCL office by 6/08/2022: 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,

Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020).

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