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25 | Licensing Program Analyst (LPA) M. Flores arrived unannounced to conduct an annual visit. LPA introduced self, stated the purpose of the visit, and toured the facility with House Manager, Shalon Bowie. Licensee, Daisy Mae Johnson was present at the facility for a few minutes to introduce herself. Direct-Care Staff, Laura Romero was also present to conclude this announced visit.
The tour started in the kitchen into the common areas, to the client's bedrooms, and bathrooms. The facility was observed to be at a comfortable temperature of degrees 71 degrees F, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. Medications, cleaning supplies and chemicals stored are locked next to the kitchen. All bedrooms were observed to have required furnishings and with adequate lightening. LPA observed four occupant rooms. Bathrooms were properly equipped, and the hot water temperature was tested at 116.9 degrees F. Fire extinguisher was observed with a service date of 4/10/23. Fire drill last completed on 10/29/23. Outside of facility toured and observed to be free of debris. Carbon monoxide and smoke detectors were tested and observed to be operational. Staff and client’s files were reviewed. First Aid checked and fully stocked.
Exit Interview conducted and Direct-Care Staff, Laura Romero whose signature on this form confirms receipt of this report. The following documents are requested and submitted to Fresno CCL by Administrator. Forms requested: LIC308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9282, and control of property will be submitted by 11/10/23. |