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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209000
Report Date: 10/29/2021
Date Signed: 10/29/2021 02:13:40 PM

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:LAURITE SENIOR CARE HOMEFACILITY NUMBER:
107209000
ADMINISTRATOR:DAVIS, MARITAFACILITY TYPE:
740
ADDRESS:5478 E LAURITE AVETELEPHONE:
(559) 246-1561
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:6CENSUS: 4DATE:
10/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Marita Davis, LicenseeTIME COMPLETED:
01:25 PM
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On 10/29/21, Licensing Program Analyst (LPA) M. Yang arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. Marita Davis, Licensee arrived shortly and conduct tour with LPA. Upon entry to the facility, LPA observed staff not wearing facial covering, staff donned a surgical face mask after Licensee arrived. Three residents were present during the tour.

Visitor log-in was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing and cough etiquette postings observed in facility. Social distancing is maintained in the common and dining areas. Fire extinguisher observed to be last serviced 06/28/2021. Cleaning supplies and chemicals were stored and locked under kitchen sink and in the garage. Food supply was checked and there appeared to be an adequate supply. LPA checked residents’ locked medications. LPA did not observe an adequate 30-day PPE supplies.

All resident’s room toured and observed to be adequately furnished and lit. LPA observed 1 shared resident’s bedroom to be at least 6 feet apart and 3 bedrooms that are single occupant. All bathrooms have trash cans with lid and securely fastened grab bars. Bathrooms have non-skid mat. Hand washing posting observed in bathroom sinks. The exterior tour was conducted. Side gate was self-closing and self-latching. Staff records were reviewed for good health and infection control training. 1 out of 4 Resident files do not have updated emergency contact information.

LPA discussed and reviewed LIC 808 including Infection control procedures to be implemented. Completed LIC 808 Mitigation Plan to be submitted to CCL by 11/11/21.

No deficiencies issued during this inspection.

Exit Interview conducted. The following updated forms were requested: Lic 308, Lic 500, Lic 610E. Lic 9020, updated Administrator certificate, and current liability insurance. Please submit the above forms to Fresno CCL by: 11/11/21. Administrator was informed that as COVID-19 precautionary measure, this report was provided via email. Report signed on-site.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 243-8080
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
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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