Facility Evaluation Report

On 6/29/2026, 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. One residents were present during inspection.

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. Dinning area observed with table and chairs. Staff room next to the dining area toured. Fire extinguisher in kitchen was expired on 6/24/2025. Tour continued to the living area which has sufficient seating. LPA toured three resident rooms upstairs which were observed to be furnished with required furniture and adequate lighting. LPA observed window screen in one resident’s room was bent. Linen supply is kept in the Hallway closet upstairs. Hallway bathroom observed to have missing baseboard with nails sticking out. Medications are kept locked in the cabinets in the laundry room. LPA observed 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 all residents. Resident's records contained signed Admission Agreement, and current Physician's Report for 2 out of 3 residents. Staff files were reviewed and had required documents.

Deficiencies are 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 7/5/2024: 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 Licensee. Appeal rights provided, Report signed on-site by Licnesee and printed copy provided.