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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209246
Report Date: 12/29/2023
Date Signed: 12/29/2023 12:27:14 PM


Document Has Been Signed on 12/29/2023 12:27 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:LAURITE SENIOR CARE HOMEFACILITY NUMBER:
107209246
ADMINISTRATOR:IDUSUYI, INNOCENTFACILITY TYPE:
740
ADDRESS:5478 E LAURITE AVETELEPHONE:
(559) 297-6771
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:6CENSUS: 5DATE:
12/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:34 AM
MET WITH:Eddiemer Sison, Assistant AdministratorTIME COMPLETED:
12:30 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, L. Padgett (LPA) arrived at facility to conduct unannounced Annual inspection. Upon arrival LPA was granted entry by staff member S1. LPA observed S1 preparing breakfast and distributing medication to 2 residents seated at the dining table. Kitchen toured, appeared clean, observed a 7-day supply of non-perishable and 2-day supply of perishable food. First Aid kit is located in bottom cabinet in the kitchen. Knives observed to be kept in locked bottom cabinet in the kitchen. Cleaning solutions and Insulin sharps are discarded in container in locked bottom kitchen cabinet. Assistant Administrator, Eddiemer Sison (AD) arrived shortly after. AD and LPA conducted a tour inside and outside of facility.

Facility observed to be clean, odor free and at a comfortable temperature. Common areas were furnished with adequate seating and lighting available. Resident rooms appeared clean and had required furnishings. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mats were observed. Hot water measure at 117.1 degrees F. Exterior tour conducted, all exits open and free of obstructions. Side gates were observed to be self-latching.

Fire extinguishers located in the kitchen and in the hallway were purchased on 10/26/2023. Smoke detectors and carbon monoxide detectors tested and found to be operational during today’s inspection. Last fire drill conducted on 12/5/2023. LPA observed cleaning supplies secured in cabinet in the garage. Door leading to the garage is maintained locked. Facility has CC camera in the dining room.

LPA reviewed staff and client records. Medications reviewed and observed to have original labels and be administered as prescribed. No deficiencies issued today.

LPA is requesting the following documents be submitted to the Fresno CCL office by 1/8/2024: Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A).

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett PadgettTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 3