Fresno Guest Home #21

Type of visit: Required - 1 Year

On 04/03/2026, Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by staff and explain the purpose of the visit. Administrator Teresa Long (AD) arrived at the facility shortly after, to assist in the inspection. The residence was set at 74 F temperature and free of passageway obstructions inside and outside. LPA observed seven bedrooms and five bathrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition with most residents rooms containing their personal furnishings. Hot water temperature was measured at 112 degrees F. Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in a laundry room closet off of the kitchen. 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 08/07/2025. Emergency disaster drills are conducted quarterly, last drill completed on 03/17/2026. First Aid kit was observed and found to be fully stocked. LPA reviewed 3 staff files and 3 client binders. There was outdoor seating for the residents in two separate areas. Grass area contained a putting green. Outdoor area was clean and free of obstruction. An exit interview was conducted, and a copy of this report was provided to AD whose signature confirms receipt. No deficiencies were cited on this day. LPA requested the following updated forms faxed to CCLD by 04/17/2026: LIC 500, Proof of current Liability Coverage.the state’s words, verbatim · CDSS document, Apr 3, 2026

Allegation investigated: Staff intimidated resident Staff did not comply with reporting requirements

Licensing Program Analyst (LPA) Daiquiri Boyd conducted the subsequent complaint investigation visit to the facility. During the course of this complaint investigation LPA interviewed staff, Administrator, and resident, as well as obtain relevant resident cell phone documentation. It was determined based on the interviews, verification of phone information, and timeline and outcome of events on 6/10/2025, that the above allegation is SUBSTANTIATED. A series of events between staff and resident led to staff placing a phone call to a resident's cell phone at 11:19pm. The verification of the call being recieved, as well as the time of night it was placed, resulted in resident feeling intimidated. Facility did not report the initial event between staff and resident to Licensing within 7 days. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 8), are being cited on the attached LIC 9099D. Substantiatedthe state’s words, verbatim · CDSS document, Oct 23, 2025 · control 24-AS-20250620105356

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a) · Plan of correction due date: Nov 6, 2025

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:... This requirement was not met as evidenced by interviews of S1 and R1 R1's cell phone log shows R1 received a call from S1 at 11:19pm. R1 said S1 yells and intimidates residents. Based on the interaction of S1 and R1 on 6/10/25, followed by removal of staff, and call log showing the received call and time of night S1 called R1, R1's Personal Rights were violated. S1 did place a call to R1 at 11:19pm, which poses a potential risk to the health, safety, or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Facility will rettrain staff at facility on personal rights and send proof with staff signatures and date of the training by 11/6 to Licensing.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Nov 6, 2025

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence... (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents...This requirement is not met as evidenced by the facility did not submit an Incident Report to Licensing within seven days. Incidents occured on 6/10/25 and were not reported until 6/20/25, which poses a potential risk to the health, safethy, or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Administrators to read and provide statement that Reporting Requirement regulations have been read and are understood. Proof with dates and signatures to be provided to Licensing by 11/6.

Type of visit: Required - 1 Year

On 04/03/2025, Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by staff and explain the purpose of the visit. Administrator Teresa Long (AD) arrived at the facility shortly after, to assist in the inspection. The residence was set at 74 F temperature and free of passageway obstructions inside and outside. LPA observed seven bedrooms and five bathrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition with most residents rooms containing their personal furnishings. Hot water temperature was measured at 115.1 degrees F. Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in a laundry room closet off of the kitchen. 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 08/05/2024. Emergency disaster drills are conducted quarterly, last drill completed on 03/02/2025. First Aid kit was observed and found to be fully stocked. LPA reviewed 3 staff files and 3 client binders. There was outdoor seating for the residents in two separate areas. Grass area contained a putting green. Outdoor area was clean and free of obstruction. An exit interview was conducted, and a copy of this report was provided to AD whose signature confirms receipt. No deficiencies were cited on this day. LPA requested the following updated forms faxed to CCLD by 04/14/2025: Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage.the state’s words, verbatim · CDSS document, Apr 3, 2025

Type of visit: Prelicensing

On 4/8/2024 at 9:00 am Licensing Program Analyst (LPA) B. Miranda arrived to the facility for an announced visit to conduct a pre-licensing inspection. LPA met with Staff Teresa Long and Arielle Ballard. Facility currently has no residents with a maximum capacity of 6. Facility is a single level residential facility with 7 bedrooms and 5 bathrooms. Facility has 6 rooms allocated for residents and one for live in staff. Facility capacity is 6 and each resident will have their own room. Residents will not share rooms at the facility. LPA toured the facility inside and out. LPA observed all fire exits to be clear and free from obstruction. LPA observed fire extinguisher to be in good standing and located in the kitchen. Laundry room is key pad locked, medication closet is located inside of the laundry room with an additional key pad lock. LPA observed first aid kit to be complete. All rooms have proper furniture with bed, linen, lighting, drawers, night stand, and closet storage space. All bedrooms have blinds for privacy. Sufficient lighting & furnishings in common area. Facility has a living room area and an outside area with furniture for residents to interact with each other. Physical plant is consistent with the facility sketch/floor plan. Smoke & carbon monoxide detectors tested & determined to be operational. LPA observed all trash cans to have lids. No deficiencies were noted at this time. Component III was also conducted and completed. Pre-licensing requirements were met. An exit interview was conducted with Staff Teresa Long and Arielle Ballard. Report signed on-site by Teresa Long and printed copy was provided.the state’s words, verbatim · CDSS document, Apr 8, 2024