<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208848
Report Date: 03/02/2022
Date Signed: 04/01/2022 03:00:14 PM


Document Has Been Signed on 04/01/2022 03:00 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:EVERSPRING RETIREMENT HOMEFACILITY NUMBER:
107208848
ADMINISTRATOR:AZADEH AKBARNEJADFACILITY TYPE:
740
ADDRESS:5738 N. LOLA AVETELEPHONE:
(559) 907-2596
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:6CENSUS: 6DATE:
03/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Alex BabkahaniTIME COMPLETED:
04:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Infection Control Inspection. LPA met with Caregiver Tess Adille and Administrator Alex Babkahani (AD) arrived shortly after. LPA entered through the central entry point where temperature was taken.

Infection control procedures which were observed or reviewed by LPA include: Daily symptoms screenings (for staff, residents and visitors), testing, visitation requirements, quarantine/isolation procedures, staffing, PPE and daily infection control procedures and vaccination requirements. All 6 residents and staff are fully vaccinated and boosted.

LPAs toured the facility inside and out. Required postings as well as Covid-19 and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Facility has designated visitation areas available. LPA observed 30-day resident medication and PPE supply. Bathroom sinks are stocked with liquid soap, hand washing signs observed.


AD has agreed to revise daily Health Screening for staff, residents and visitors and submit a copy to LPA. by 3/11/22.



No deficiencies cited during today’s visit.

A copy of this report was provided and an exit interview was conducted with AD.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1