Facility Evaluation Report

On 3/16/2026, Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. LPA was greeted by Staff (S1) Eehai See. Licensee (L1) Eesaeng Martinez arrived shortly after LPA’s arrival. 1 resident was present during inspection as the other 3 were attending day program.

LPA conducted a tour of the facility with L1. During the inspection the facility appeared clean and odor free and at a comfortable temperature. Common areas were furnished and had adequate seating and lighting available. Refrigerator temperature measured at 39 degrees F. Freezer temperature measured at -3 degrees F. Resident bedrooms appeared clean and had required furnishings and adequate lighting. Residents’ bathrooms appeared clean, water temperature was tested at 111.5 to 118.5 in 2 bathrooms. Facility kitchen appeared to be clean and safe for food preparation. LPA observed 2-day supply of perishable foods and a 7-day supply of non-perishable food. First aide kit reviewed to have all the required items.

Exterior tour conducted, all exits open and free of obstructions during today’s visit. Fire extinguisher is current, last serviced on 3/3/2026. Smoke detectors and carbon monoxide detector operational per quarterly reports given to LPA. Last fire drill conducted on 1/22/2026. Cleaning supplies observed to be locked and inaccessible to residents in care. LPA reviewed client and staff files. Medications observed to be locked and administered as prescribed. All client files and samples of resident files reviewed to have all the required documents.

No deficiencies issued during today's inspection.

LPA is requesting the following documents be submitted to the Fresno CCL office by 3/31/2026: 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.

Exit interview conducted. A copy of this report was discussed and provided to Licensee whose signature on this form confirms receipt of this document.