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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209219
Report Date: 07/30/2026
Date Signed: 07/30/2026 06:43:20 PM

Document Has Been Signed on 07/30/2026 06:43 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:KAWEAH HEALTH RUTH WOOD OPEN ARMS HOUSEFACILITY NUMBER:
547209219
ADMINISTRATOR/
DIRECTOR:		BECERRA, JACKLYNFACILITY TYPE:
740
ADDRESS:3234 W. IRIS AVE.TELEPHONE:
(559) 625-0139
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 6CENSUS: 5DATE:
07/30/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:59 AM
MET WITH:Administrator Jacklyn BecerraTIME VISIT/
INSPECTION COMPLETED:
06:45 PM
NARRATIVE
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On 7/30/2026, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Administrator Jacklyn Becerra.

LPA conducted facility tour with Administrator Jacklyn Becerra. All pathways, entrances and exits were clear from obstructions. The tour started in kitchen, continued to dining room, living room and resident rooms. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Sharps are locked in kitchen cabinet. Facility Laundry room is connected to Kitchen. Laundry room observed locked with cleaning supplies and chemicals. Office area observed with back up supplies and cleaning supplies; Office is kept locked when no one is present. Dining room and Living room observed with sufficient seating and activities for residents. Facility has five residents at this time. LPA toured several bedrooms which were observed to be furnished with required furniture and adequate lighting. Four residents observed with full bed rails. Bathrooms were properly equipped with non-slip mats and grab bars. Fire extinguishers were last serviced on 6/1/2026 and was fully charged. Linen supply is kept in the hallway closet. Carbon monoxide and smoke alarm detectors installed and operational. LPA observed sufficient seating under covered patio area in the back of the facility. Side gate was self-closing and self-latching. Medications are kept in locked cabinets in the hallway. Last fire drill was conducted on 5/06/2024. Resident's records contained signed Admission Agreement, Personal Rights, and Emergency Identifications forms. 3 out of the 5 residents had current Physician's Reports. During medication audit LPA observed 2 out of 5 residents that had a missed dose of medication. 2 out of 5 residents PRN medication was not logged or was logged without the required information. Facility failed to have appraisal needs and service plan for residents and Hospice Care Plan did not have facility duties outlined for providing care to residents. Staff files were reviewed for good health. It was verified that current staff on duty is CPR certified.

Alexandria Walton
Kamaldeep Kaur
DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2026
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 13
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/30/2026 06:43 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 07/30/2026 at 04:57 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KAWEAH HEALTH RUTH WOOD OPEN ARMS HOUSE
FACILITY NUMBER: 547209219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(c)(3)
Incidental Medical and Dental Care Services
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 5 residents PRN medication was not logged or was logged without the required information which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/06/2026
Plan of Correction
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Administrator agrees to provide a in-service training regarding PRN medication regulations and submit records of training and copies of corrected PRN Medication Logs by due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Alexandria Walton
NAME OF LICENSING PROGRAM MANAGER:
Kamaldeep Kaur
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2026


LIC809 (FAS) - (06/04)
Page: 6 of 13
Document Has Been Signed on 07/30/2026 06:43 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 07/30/2026 at 04:57 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KAWEAH HEALTH RUTH WOOD OPEN ARMS HOUSE
FACILITY NUMBER: 547209219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(a)(4)
Incidental Medical and Dental Care Services
(4) The licensee shall assist residents with self-administered medications as needed.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 5 residents had missed doses of medication which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2026
Plan of Correction
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Administrator agrees to submit a statement of intent by due date to conduct medication in-service training and submit records of training when completed.
Type A
Section Cited
CCR
87608(a)(5)(B)
Postural Supports
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in four out of 5 residents had full bed rails without a physician order in hospice care plan which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2026
Plan of Correction
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Administrator agrees to remove full bed rails until a full bed rail physician order is in place.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Alexandria Walton
NAME OF LICENSING PROGRAM MANAGER:
Kamaldeep Kaur
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2026


LIC809 (FAS) - (06/04)
Page: 4 of 13
Document Has Been Signed on 07/30/2026 06:43 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 07/30/2026 at 04:57 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KAWEAH HEALTH RUTH WOOD OPEN ARMS HOUSE
FACILITY NUMBER: 547209219

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87633(b)(4)
Hospice Care for Terminally Ill Residents
(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (4) A description of the licensee's area of responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident's physician, and the resident's responsible person(s), if any. This description shall include the type and frequency of the tasks to be performed by the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 5 out of 5 residents hospice care plan did not document facility staff duties regarding care which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2026
Plan of Correction
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Administrator agrees to develop a needs and service plan/ care plan regarding facility staff duties for care and submit documentation to CCLD by due date.
Type A
Section Cited
CCR
87458(a)

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.

This requirement is not met as evidenced by:

Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 2 out of 5 residents did not have a medical assessment on file which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2026
Plan of Correction
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Administrator agrees to have medical assessments completed and submit them to CCLD by due date
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Alexandria Walton
NAME OF LICENSING PROGRAM MANAGER:
Kamaldeep Kaur
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2026


LIC809 (FAS) - (06/04)
Page: 5 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: KAWEAH HEALTH RUTH WOOD OPEN ARMS HOUSE
FACILITY NUMBER: 547209219
VISIT DATE: 07/30/2026
NARRATIVE
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Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6.

LPA is requesting the following documents be submitted to the Fresno CCL office by 8/06/2026: Current copy. of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020.

Exit interview conducted, plan of corrections were reviewed and developed with Administrator Jacklyn Becerra. A copy of this report and appeal rights were discussed and provided to Administrator whose signature on this form confirms receipt of this document.

NAME OF LICENSING PROGRAM MANAGER: Alexandria Walton
NAME OF LICENSING PROGRAM ANALYST: Kamaldeep Kaur
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC809 (FAS) - (06/04)
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