Attentive Senior Care III

Type of visit: Required - 1 Year

On 11/12/25 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Licensee (L1) Lawrence Holland. LPA was granted entry. 0 clients are currently not placed in facility. LPA toured facility with L1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. No food was observed in refrigerator or freezer because of no residents in facility. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 37 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Fire extinguisher was observed with a service date of: 12/6/24. Fire drill currently not conducted because of vacancy of residents in facility. Clients' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a range 105.4 degrees F in bathroom 1 and 108.8 degrees F in 2 bathrooms. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Medications not present in facility because of vacancy. Facility does have a Centrally Stored Medication Record designation in locked closet. Carbon monoxide and smoke detectors were tested and observed to be operational. No clients’ file reviewed because of vacancy in the facility. No staff files were reviewed as facility does not currently have staff. Licensee and Administrator was advised that staff files will need to be present and ready for review in facility. No deficiencies issued during this inspection. Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 11/26/25: Lic 308, Lic 500, Lic 610D, Lic 9020 and Administrator Certificate. A copy of this report was provided to Licensee, whose signature on this form confirms receipt of these report.the state’s words, verbatim · CDSS document, Nov 12, 2025

Type of visit: Required - 1 Year

On 11/19/24 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Licensee (L1) Lawrence Holland. LPA was granted entry. 0 clients are currently not placed in facility. Administrator Paulette Holland (A1) arrived shortly after LPA’s arrival. LPA toured facility with L1 and A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. No food was observed in refrigerator or freezer because of no residents in facility. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 37 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Fire extinguisher was observed with a service date of: 2/8/23. Fire drill currently not conducted because of vacancy of residents in facility. Clients' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested 114.2 degrees F in bathroom 1 and 118.4 degrees F in bathroom 2. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Medications not present in facility because of vacancy. Facility does have a Centrally Stored Medication Record designation in locked closet. Carbon monoxide and smoke detectors were tested and observed to be operational. No clients’ files reviewed because of vacancy in the facility. No staff files were reviewed as facility does not currently have staff. Licensee and Administrator was advised that staff files will need to be present and ready for review in facility. No deficiencies issued during this inspection. Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 12/3/24: Lic 308, Lic 500, Lic 610D, Lic 9020 and Administrator Certificate. A copy of this report was provided to Licensee, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Nov 19, 2024

Type of visit: Prelicensing

The following items have been brought into compliance: 1. Theft policy and investigative procedures have been posted. 2. Grab bars have been installed in the hallway bathroom. 3. flashlights purchased, hallway night lights installed. 4. Bedroom furniture - each resident has a chair 5. Following items have been posted personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475). The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility 8. The text of this section with the heading “Rights of Resident Councils” shall be posted in a prominent place at the facility accessible to residents, family members, and resident representatives. 9. Family councils shall be provided adequate space on a prominent bulletin board or other posting area for the display of meeting notices, minutes, information, and newsletters. 10. Complete first aid kit observed. 11. Faucets temperature measured at 115.4 degrees. Component III was conducted and completed. Exit interview was conducted. Pre-licensing requirements were met. An exit interview was conducted with Licensee. Report signed on-site by Licensee and printed copy provided.the state’s words, verbatim · CDSS document, Dec 12, 2023

Type of visit: Prelicensing

On 11/03/23, Licensing Program Analyst (LPA) K.Kaur conducted an announced Pre-licensing and Component III inspection. LPA introduced self, stated the purpose of the visit, and was granted entry into the facility. LPA met with Licensee Paulette Holland. LPA toured facility with Licensee. The facility is a 3 bedroom and 2-bathroom home. Fire clearance was granted for 1 non-Ambulatory for total of 6 capacity and one bedridden client in the master bedroom. The facility was observed to be at a comfortable temperature of 73 degrees F, furnished with adequate seating. A fire extinguisher was observed and has a service date of 04/17/2023. Medications will be kept locked in a cabinet in the living room/dining area. Kitchen was toured and observed to have dishes, plates, and utensils. Knives were observed to be locked and secured in the cabinets near the eating nook. Cleaning chemicals was observed stored and locked in under kitchen counter. LPA observed an extra supply of bed linens and personal hygiene products in hallway closet. Bedrooms were observed to have required furnishings aside from chairs for each resident. All bathrooms toured and were operational during inspection. LPA observed bathroom with securely fastened grab bars and non-skid mat. Toilets are missing grab bars or raised toilet seat with handles. Hot water measured at 122.4 F in the bathroom sink. Washer and dryer observed in laundry room. Outside of facility toured and observed with seating under patio area. LPA observed side gate to be self-closing that needed to be lifted up to open. Carbon monoxide and smoke detectors were tested and observed to be operational. First aid kit not observed. The Licensee has not met all Pre-Licensing requirements. The following will need to be brought into compliance: 1. Establishment and posting of the facility’s policy regarding theft and investigative procedures 2. Water supplies and plumbing fixtures shall be maintained as follows: (4) Grab bars shall be maintained for each toilet, bathtub and shower used by residents. 3. Emergency lighting shall be maintained. At a minimum this shall include flashlights, or other battery powered lighting, readily available in appropriate areas accessible to residents and staff. Open-flame lights shall not be used. 4. Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. 5. Night lights shall be maintained in hallways and passages to nonprivate bathrooms. 6. Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. 7. Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475). The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility 8. The text of this section with the heading “Rights of Resident Councils” shall be posted in a prominent place at the facility accessible to residents, family members, and resident representatives. 9. Family councils shall be provided adequate space on a prominent bulletin board or other posting area for the display of meeting notices, minutes, information, and newsletters. 10. complete first aid kit shall be maintained 11. Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C) Due to corrections needing to be made the Pre-Licensing was not passed and Component III was not completed. No deficiencies cited during today’s visit. Exit interview completed with Licensee and a copy of this report was printed and provided.the state’s words, verbatim · CDSS document, Nov 3, 2023

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call Census (if any clients in care): Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Oct 30, 2023

Type of visit: Office

COMP II by CAB successfully completed Capacity: 6 Census (if any clients in care): Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Oct 24, 2023