Facility Evaluation Report
On 06/7/2023, 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 staff Nida Pira. Staff contacted Licensee Jose Pira, who arrived a short time later.
All pathways, entrances and exits were clear from obstructions. LPA and staff began the tour at the facility
kitchen. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. At 11:23 LPA observed the kitchen cabinets to have built up grease. Fire extinguisher in kitchen was last serviced on 5/16/2023 and was fully charged. Tour continued to the living room which has sufficient seating. LPA toured four resident bedrooms which were observed to be furnished with required furniture and adequate lighting. Linen supply is kept in the hallway closet. At 12:05 LPA observed bathroom fan cover to have dust buildup. Cleaning supplies and chemicals are kept locked in laundry room. Medications are kept in the Kitchen cabinet. At 12:46 LPA reviewed resident’s medication with the MARs and centrally stored list and observed the current medication bubble packs were not documented in the Centrally Stored List. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health. Staff files had First Aid training. LPA observed sufficient seating under covered patio area in the back of the facility.
Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22,
LPA is requesting the following documents be submitted to the Fresno CCL office by 6/14/2023: 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.
Exit interview was conducted. Report signed on-site; printed copy of report provided with appeal rights.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction