Facility Evaluation Report

On 12/31/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required annual inspection. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. Administrator provided a tour of the facility inside and out. Administrator on record is Ricardo Andres, Certificate#7005390735, Exp. 05/31/26.

LPA observed 4 residents in care at the time of visit. Facility is a 6 bedroom 5 bathroom home. 4 out of the 6 bedrooms are designated for residents. 1 Residents bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. Facility temperature was degrees F.

Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 118 degrees F. Trash can with lid and hand washing postings were observed.

Medications were observed to be locked in a cabinet located in the kitchen. Cleaning supplies were observed to be locked under the kitchen sink. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored.

Carbon monoxide and smoke detectors were tested and observed to be operational. Fire Extinguisher was observed with a service date of 09/18/24. First aid kit was observed and contained all required items. The exterior tour of back yard was conducted and found to be free from debris. A covered outdoor seating area was observed for residents in care. Side gate was self-closing and self-latching.

Residents’ files were reviewed and observed to have update emergency contacts, Admission agreement, and current physician report/individual performance plans (IPP). A sample of staff files were also reviewed. Staff files were observed to have current First Aid/CPR. Staff are fingerprinted clear and associated to the facility.

Quarterly Emergency Disaster Drill logs were observed for staff. LPA observed on the LIC 610D (Emergency Disaster Plan) with emergency numbers and evacuations locations was posted in the kitchen. .

An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.

LPA is requesting the following documents be submitted to the Fresno CCL office by 07/03/2024: 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, and Surety Bond.