Facility Evaluation Report

On 5/7/2024, 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 House Manager Kristal Gomez. Staff contacted Administrator Tami Leyva who arrived a short while. LPA conducted tour with Staff. The facility was observed to be at a comfortable temperature, clean, in good repair, with no passageway obstructions or fire hazards. Sufficient perishable food supplies observed. Fire extinguisher in the Kitchen was last serviced on 01/25/2024 and was fully charged. All common areas were properly furnished and well-lit throughout. Medications, First Aid, and Sharp items locked in the kitchen cabinets. Smoke Alarm and Carbon Monoxide detector tested and operational. LPA toured 4 resident rooms and an office. All client bedrooms toured and observed to be adequately furnished. Extra linens observed in the hallway closet. LPA toured laundry area which appeared clean. LPA observed cleaning supplies and chemicals unlocked in cabinet next to laundry. LPA observed paint bucket unlocked near laundry area. The exterior tour was conducted. Car wash bottle observed unlocked in the garage. The backyard was observed to have sufficient. A covered area is provided during the summer. Medication was reviewed. Staff records were reviewed for good health and training, all clients’ records reviewed to have Admission Agreement, Physician’s Report and emergency contact information. Last fire drill completed on 4/16/2024.

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 5/14/2024: 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 Administrator. Report signed on-site; a printed copy was provided including appeal rights.