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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206929
Report Date: 07/20/2022
Date Signed: 07/20/2022 04:25:18 PM


Document Has Been Signed on 07/20/2022 04:25 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:PAINTBRUSH ASSISTED LIVING AND MEMORY CAREFACILITY NUMBER:
107206929
ADMINISTRATOR:JENNIFER VASQUEZFACILITY TYPE:
740
ADDRESS:4356 W ASHLAN AVETELEPHONE:
(559) 275-2000
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:110CENSUS: 87DATE:
07/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jennifer VasquezTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Annual Infection Control Inspection. LPA met with and explained the purpose of the visit with Administrator (AD) Jennifer Vasquez.

LPA toured the facility inside and out with AD, including randomly selected resident apartments. Infection control procedures which were observed and/or reviewed by LPA include: Daily symptom screenings for staff, residents and visitors, resident and staff vaccination, testing, visitation requirements, quarantine/isolation procedures, staffing plan, PPE and daily infection control procedures. Sanitizer is available throughout the facility. Furniture in common and dining areas are spaced to promote distancing. Facility has designated visitation areas available. LPA observed 30-day supply of PPE, cleaning and disinfecting products were observed and locked. LPA observed 2-day perishable and 7-day nonperishable food supply. AD has agreed to post additional hand washing and symptom related signs in restrooms and common areas.

No deficiencies cited during this inspection.


A copy of this report was provided, and an exit interview was conducted with AD.




LPA requested the following updated forms by 7/27/22: LIC 308, LIC 309, LIC 402, LIC 500, LIC 610E. Infection Control Plan has been submitted.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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