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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208835
Report Date: 03/25/2022
Date Signed: 04/01/2022 08:55:49 AM


Document Has Been Signed on 04/01/2022 08:55 AM - 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:CREST POINTE ASSISTED LIVING-PRESCOTTFACILITY NUMBER:
107208835
ADMINISTRATOR:KEENE, ALICIAFACILITY TYPE:
740
ADDRESS:2855 PRESCOTT AVENUETELEPHONE:
(559) 765-4321
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY:6CENSUS: 6DATE:
03/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Alicia KeeneTIME COMPLETED:
02:14 PM
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Today, Licensing Program Analyst L. Xiong arrived at the facility unannounced to conduct the Infection Control Inspection. LPAs met Administrator Alicia Keene and inform her the purpose of the visit. LPA completed the Covid-19 Contact questionnaire prior to entrance into the facility.

LPAs observed a central entry point with a supply of hand sanitizer and a sign in policy that includes documented routine symptom screening for resident's, staff and visitors.

Mitigation plan has been submitted to Community Care Licensing. Infection control procedures described in the plan and observed by LPAs include: Daily symptoms screenings (for staff, persons in care and visitors), visitation policy, quarantine/isolation procedures, surveillance testing, infection control plan and identification of Alicia Keene as the Infection Control Lead, emergency staffing, PPE use, infection control training and procedures, documentation, postings and communication. LPAs reviewed Mitigation Plan and procedures with the Program Director.

LPAs toured the facility inside and out. Required postings of signs to include hand washing, coughing etiquette and physical distancing were observed in the facility. Staff were all observed wearing face coverings. Facility has designated visitation areas. LPAs observed a 30 day supply of PPE and resident medications. Sinks are well stocked and liquid soap for hand washing and paper towels for hand drying were observed.

Through LPA’s observations with licensee, the required infection control practices are found to be in compliant. No deficiencies cited on today’s inspection.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Les XiongTELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2022
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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