Community Care Licensing

Document Has Been Signed on 01/02/2025 10:44 AM - It Cannot Be Edited

FACILITY NAME:	BONAVENTE HOME FOR THE ELDERLY #2		FACILITY NUMBER:	107207113
ADMINISTRATOR/ DIRECTOR:	BONAVENTE, NIDA		FACILITY TYPE:	740
ADDRESS:	6097 HARRISON		TELEPHONE:	(559) 313-9052
CITY:	FRESNO	STATE: CA	ZIP CODE:	93711
CAPACITY: 6		CENSUS: 5	DATE:	12/26/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:09 AM
MET WITH:	Administrator, Rosemarie		TIME VISIT/ INSPECTION COMPLETED:	06:26 PM

SUPERVISORS NAME: See Moua LICENSING EVALUATOR NAME: Mary Garza LICENSING EVALUATOR SIGNATURE: DATE: 12/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/26/2024

Link to Parent Document Below:

FACILITY NAME: BONAVENTE HOME FOR THE ELDERLY #2	FACILITY NUMBER: 107207113
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/26/2024

Type A

Section Cited

HSC

1569.618(c)(3)

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, the licensee did not comply with the section cited above in that staff files reviewed did not have required CPR/1st Aid certificates. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2024
	Plan of Correction
1 2 3 4	Administrator will contact trainer to see if CPR is included in the training provided. If not, Staff will complete course online by POC date. Updated certificate will be submitted to CCL as proof of correction.

Type A

Section Cited

HSC

1569.267(d)

(d) The licensee shall provide initial and ongoing training for all members of its staff to ensure that residents’ rights are fully respected and implemented. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation of staff files not having required training, the licensee did not comply with the section cited above in 2 of 2 staff files reviewed. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2024
	Plan of Correction
1 2 3 4	Administrator stated a plan of correction will be submitted to CCL in writting by POC date. This will include dates that staff will have the training completed by.

SUPERVISOR'S NAME: See Moua LICENSING EVALUATOR NAME: Mary Garza LICENSING EVALUATOR SIGNATURE: DATE: 12/26/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/26/2024

Link to Parent Document Below:

FACILITY NAME: BONAVENTE HOME FOR THE ELDERLY #2	FACILITY NUMBER: 107207113
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/26/2024

Type A

Section Cited

HSC

1569.319(b)(1)

(b) A licensee shall ensure the following requirements are met in providing any internet access device for resident use: (1) The device shall be available in a manner that allows a resident to access it for discussion of personal or confidential information with a reasonable level of personal privacy. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, the licensee did not comply with the section cited above in that the facility has a computer in the living room that does not have a camera and is inaccessible to residents. Facility does not have a device for resident use. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2024
	Plan of Correction
1 2 3 4	Administrator stated they will provide a POC in writting by POC date. Administrator stated a device will be purchased and provided to the residents. A receipt will be provided as proof of correction.

Type A

Section Cited

HSC

1568.044

(a) A facility shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation of the emergency disaster plan, the licensee did not comply with the section cited above in that the plan was incomplete and without the required documentation. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2024
	Plan of Correction
1 2 3 4	Administrator stated they will update the emergency disaster plan and submit to CCL by POC date as proof of correction.

SUPERVISOR'S NAME: See Moua LICENSING EVALUATOR NAME: Mary Garza LICENSING EVALUATOR SIGNATURE: DATE: 12/26/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/26/2024

Link to Parent Document Below:

FACILITY NAME: BONAVENTE HOME FOR THE ELDERLY #2	FACILITY NUMBER: 107207113
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/26/2024

Type B

Section Cited

CCR

87219(a)(1)

(a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include: (1) Socialization, achieved through activities such as group discussion and conversation, recreation, arts, crafts, music, and care of pets. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA interviews, the licensee did not comply with the section cited above in that facility does not have activities for the residents. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/03/2025
	Plan of Correction
1 2 3 4	Administrator stated they will generate a schedule for activites to include the resdents in. A copy will be submitted to CCL by POC date.

Type B

Section Cited

CCR

87303(a)

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, the licensee did not comply with the section cited. Right front walkway slippery. Right front light non-functioning. Bedroom #3 has broken outlet cover. Dishwasher non-functioning. Pool non-functioning & has dirty water. Mattress in R1's bedroom in need of replacement. R1's bedroom in need of touch up paint (near bed & near closet). R1's bedroom missing nightstand. Bedroom #2 restroom has broken tiles and shower in need of cleaning. Laundry room observed with holes in wall. Vent in laundry room in need of cleaning. Bedroom #3 door in need of repair. Bathroom #2 observed with bathtub and sinks in need of resurfacing and shower in need of cleaning. Bathroom #2 cabinets in need of repair or replacement. Bathroom #2 toilet missing toilet cover. Bathroom #3 in need of paint around toilet. Bedroom #4 missing nightstand. Backyard patio roof observed with holes in need of repair. Freezer in garage in need of defrosting. Box spring in garage observed with hole and in need of disposal. Oxygen tank without stand/strapped down observed in garage in need of removal/disposal. Garage observed with debris in need of removal. Back door window observed broken in need of repair. Large left side gate broken and in need of repair. Wires exposed on HVAC unit in need of repair. Right side gate does not open/close properly in need of repair. Tiles in front walkway missing or cracked in need of repair/replacement. Driveway observed with missing concrete in need of repair. Back door trim in need of replacement. Kitchen observed with spider webs/dust above stove and on fan above table. Bathroom #3 observed with smell of urine. Kitchen tiles broken and in need of replacement near sink. . This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/03/2025
	Plan of Correction
1 2 3 4	Administrator stated discussions with Licensee and Designee will be completed and a POC will be submitted to CCL in writing by POC date. As corrections are being completed a log will be kept of the corrections completed and pictures will be sent as proof of correction.

SUPERVISOR'S NAME: See Moua LICENSING EVALUATOR NAME: Mary Garza LICENSING EVALUATOR SIGNATURE: DATE: 12/26/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/26/2024

FACILITY NAME: BONAVENTE HOME FOR THE ELDERLY #2	FACILITY NUMBER: 107207113
	VISIT DATE: 12/26/2024