Facility Evaluation Report

On 10/22/2021, Licensing Program Analyst (LPA) M. Yang arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA was met by caregiver Veronica Coronado and house manager Damon Bly. Upon entry staff was observed not wearing facial covering. LPA conduct tour with house manager. Elissa Duhaylonsod, administrator arrived in a short time later and conduct tour with LPA. All four residents were present during the tour.

Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. LPA observed cough etiquette signs and social distancing. Food supply was checked and there appeared to be an adequate supply. LPA checked residents’ locked medications. LPA observed fire extinguishers with a service date of: 06/32/20. LPA did not observe a 30-day PPE supplies. All bathrooms are observed with trash cans with lid. LPA observed hand washing posting by bathroom sinks. All resident’s room that are single occupant toured and observed to be adequately furnished and lit.

The exterior tour was conducted. Side gate was self-closing and self-latching. Staff records were reviewed for good health and infection control training. All residents have updated emergency contact information.

A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6.

Exit interview was conducted. Please submit the following forms/information to Fresno CCL by: 10/28/21. Requested forms/ information: LIC 308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9020, and current lease agreement. LPA received copy of Administrator Certificate during facility inspection. Due to COVID-19 precautionary measures, a copy of this report and appeal rights will be provided via email. Report signed on-site