Evergreen Carehome I

Type of visit: Required - 1 Year

On 10/01/2026, Licensing Program Analyst (LPA) M Vega conducted an unannounced Annual visit. LPA was allowed entry by facility staff and Administrator was contacted of LPA presence in facility. Administrator - Sukhpreet Kaur arrived a short time later. LPA reviewed Staff and Resident files. Resident files observed to have updated information. MAR was reviewed and was accurate and up to date at time of inspection. LPA began the tour at the entrance of the facility that has one entrance point. LPA toured the inside and outside of the facility. The facility was observed at a comfortable temperature of 75 degrees Fahrenheit. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas furnished and well-lit throughout. LPA observed the kitchen to be absent of any trash or debris, sharp objects are secured and inaccessible to residents in care. At this time, seven day supply of non-perishable food were observed. Resident’s all bedrooms were observed to be furnished with bed, dresser, night stand, and overhead lightning. Mattresses, box springs, sheets, and linens, were absent of any tears and stains. Bathrooms and showers were equipped with non-skid flooring and securely fastened grab bars. The bathroom water temperature was tested at 112.2 degree Fahrenheit. Towels, linens, and personal hygiene supplies were observed in storage. This facility does not have any bodies of water. All Fire extinguishers are current with service date of 09/09/2026. Carbon monoxide and smoke detectors were observed to be operational. Continuation on LIC 809C Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate and up to date information for your facility. In an effort to maintain your facility file, please submit the most current and complete forms and/or information as identified below: Residential Care Facility for the Elderly (RCFE) LIC 308 Designation of Facility Responsibility LIC 309 Administrative Organization LIC 400 Affidavit Regarding Client/Resident Cash Resources LIC 402 Surety Bond LIC 500 Personnel Report LIC 610E Emergency And Disaster Plan For Residential Care Facilities For The Elderly LIC 9020 Register of Facility Clients/Residents Copy of current Liability Insurance Copy of current Administrator Certificate Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 10/15/2026 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed. No deficiencies issued during this inspection. An exit interview was conducted with the Administrator - Sukhpreet Kaur. A copy of this report was given to Administrator whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Oct 1, 2026

Type of visit: Case Management - Incident

On 12/23/25 Licensing Program Analyst (LPA), M Vega to conduct an unannounced case management visit. LPA met with Administrator (AD) - Sukhpreet Kaur and arrived some time later. This case management visit is being conducted for an Special Incident Report (SIR) dated 10/23/2025, regarding Resident 1(R1) not having medications upon moving in to facility. LPA requested and reviewed documentation (R1 602A, Centrally Stored, Release forms). At this time this case management does not need further review. AD was informed that additional documentation maybe needed. No deficiencies cited during todays visit. Exit interview completed with AD - Sukhpreet Kaur. A copy of this report was provided for facility records.the state’s words, verbatim · CDSS document, Dec 23, 2025

Type of visit: Post Licensing

On 11/13/2025, Licensing Program Analyst (LPA) M Vega, arrived at the facility for the purpose of conducting a post-licensing inspection. LPAs were greeted by Administrator - Sukhpreet Kaur. LPAs toured the facility inside and outside. The facility was observed to be clean, free from clutter and was odor free. The facility was observed at a comfortable temperature of 76 degrees Fahrenheit. The common area rooms were observed to have adequate furnishings, window coverings and lighting. LPAs inspected all resident rooms and observed them to be with in regulatory requirements. All bedrooms had the required furniture, to include beds with good mattresses, night stands, and chairs. All rooms had overhead lighting. Hot water temperature was observed to be 114.9 F in the common restroom. Showers had slip resistant flooring with grab bars. In addition, there were grab bars structure on the toilets. LPA observed an adequate amount of perishable and nonperishable food. There was also 72 hours of emergency food and water properly stored. All Fire extinguishers are current 09/03/2025. Carbon monoxide and smoke detectors were observed to be operational. First Aid Kit was checked and observed to have the required supplies. No deficiencies were observed on this visit. Post-Licensing is complete. A signed copy of this form was provided to administrator for facility records.the state’s words, verbatim · CDSS document, Nov 13, 2025

Type of visit: Prelicensing

On 09/24/2025, Licensing Program Analyst (LPA) M Vega, arrived at the facility for the purpose of conducting a pre-licensing inspection. LPAs were greeted by Administrator - Sukhpreet Kaur. LPAs toured the facility inside and outside. The facility was observed to be clean, free from clutter and was odor free. The facility was observed at a comfortable temperature of 75 degrees Fahrenheit. The common area rooms were observed to have adequate furnishings, window coverings and lighting. LPAs inspected all resident rooms and observed them to be with in regulatory requirements. All bedrooms had the required furniture, to include beds with good mattresses, night stands, and chairs. All rooms had overhead lighting. Hot water temperature was observed to be 110.8 F in the common restroom. Showers had slip resistant flooring with grab bars. In addition, there were grab bars structure on the toilets. LPA observed an adequate amount of perishable and nonperishable food. There was also 72 hours of emergency food and water properly stored. All Fire extinguishers are current 09/03/2025. Carbon monoxide and smoke detectors were observed to be operational. First Aid Kit was checked and observed to have the required supplies. Emergency exit plan, required phone numbers, and required postings were observed. A working facility has a working phone and 559-940-6648 was present and functional. Component III was reviewed with Administrator. No deficiencies were observed on this visit. Pre-Licensing is complete and this facility has no deficiencies.the state’s words, verbatim · CDSS document, Sep 24, 2025