Facility Evaluation Report

On 8/01/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Licensee Jared Sandoval. Residents were attending day program.

All pathways, entrances and exits were clear from obstructions. LPA and Licensee began tour at the facility kitchen. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Fire extinguisher in kitchen was last serviced on 5/10/2023 and was fully charged. Tour continued to the living room which has sufficient seating. LPA toured three resident rooms upstairs which were observed to be furnished with required furniture and adequate lighting. At 10:33 AM LPA observed the resident bedroom carpet to have stains. Master bedroom and bathroom were observed with debris on the floor; bathrooms and showers observed with stains. Linen supply is kept in the Hallway closet upstairs. Cleaning supplies and chemicals are kept locked in the laundry room and garage. Medications are kept locked in the cabinets in the laundry room. LPA observed sufficient seating under covered patio area. Backyard gate was self-latching and self-closing. Carbon monoxide and smoke alarm detectors installed and operational. LPA reviewed resident’s medication and Centrally Stored List for any residents. Resident's records contained signed Admission Agreement, and current Physician's Report. Frill Drill records were reviewed. At 11:46 LPA observed Staff files were missing Health screening and TB results. Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6.

LPA is requesting the following documents be submitted to the Fresno CCL office by 8/15/2022: 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

(LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

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