Fresno Guest Home #15

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA explained the purpose of the visit and was granted entry by caregiver staff. Administrator, Angelica Kutnerian (AD1) and Assistant, Jaycee Sanderson (AD2) arrived at the facility minutes after. The residence was set at 75 degrees F temperature and free of passageway obstructions inside and outside. LPAs observed six bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Hot water temperature was measured at 113.2 degrees F. Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in the kitchen area. Cleaning supplies were locked in the laundry room. Smoke detectors and carbon monoxide are dual detectors, they were checked and operating. Fire extinguishers were charged and was serviced on 08/02/2023. Emergency disaster drills are conducted quarterly, last drill completed on 9/01/23. First Aid kit is fully equipped. There was outdoor seating for the residents. Outdoor area was clean and free of obstruction. An exit interview was conducted, and a copy of this report was provided to AD2 whose signature confirms receipt. LPA requested the following updated forms faxed to CCLD by 11/10/23: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage.the state’s words, verbatim · CDSS document, Nov 7, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lady Cabrera arrived unannounced for an Annual Required Inspection. LPA met with Licensee Representative Angela Kutnerian. LPA stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trashcans with lid. Hand washing posters were observed by the bathrooms. Bedrooms were checked. The exterior tour was conducted. LPA checked residents’ medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. Exit interview was conducted. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency 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: 09/02/2022. 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.the state’s words, verbatim · CDSS document, Aug 22, 2022

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Lady Cabrera conducted a Pre-licensing visit. LPA identified herself and discussed the purpose of the visit. LPA conducted the inspection with Administrator George Kutnerian and Licensee Representative Angelica Kutnerian-Gless using the Inspection Tool. A tour inside and outside the facility was conducted. Common rooms have adequate furnishings and lighting. All client’s bedrooms have all the required furnishings (bed and dresser) and adequate lighting. Mattresses were in good condition. All rooms will be private. Home is fire cleared for six non-ambulatory elderly residents. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Bathrooms were properly equipped, and trash cans had a fitting lid. Hot water temperature was observed to be 108.6 degrees F. Kitchen observed to have dishes, plates, utensils. Sharps/knives and medications are locked in the kitchen. Cleaning supplies are stored. First aid kit contains all the required items. Fire extinguisher is present and was serviced in January 4, 2021. Smoke detectors and carbon monoxide were operating properly. Outside of the facility toured. Exits open free of obstruction. Gate is self-latching. No outside hazards were observed. All required postings are posted. Facility phone number will be (559) 434-1839. Component III conducted during pre-licensing inspection. LPA have found that applicant has met all pre licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued. Pre-Licensing is complete and this facility has no deficiencies.the state’s words, verbatim · CDSS document, Aug 3, 2021