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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209246
Report Date: 12/18/2024
Date Signed: 01/07/2025 02:34:25 PM

Document Has Been Signed on 01/07/2025 02:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:LAURITE SENIOR CARE HOMEFACILITY NUMBER:
107209246
ADMINISTRATOR/
DIRECTOR:
SISON, EDDIEMERFACILITY TYPE:
740
ADDRESS:5478 E LAURITE AVETELEPHONE:
(559) 573-7999
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 4DATE:
12/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Innocent Idusuyi, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Rachel Bruce arrived at facility to conduct unannounced Annual Inspection. Upon arrival LPA was granted entry by staff member, Edna Donel, Caregiver (CG). CG provided tour of facility inside and outside. Kitchen toured, appeared clean, observed a 7-day supply of non-perishable and 2-day supply of perishable food. Secondary refrigerator for overflow and storage of food is located in garage. First Aid kit is located in bottom cabinet in the kitchen. Knives observed to be kept in locked bottom cabinet in the kitchen. Cleaning solutions and Insulin sharps are discarded in container in locked bottom kitchen cabinet. Licensee, Innocent Idusuyi (L) arrived shortly after.

Facility observed to be clean, odor free and at a comfortable temperature. Common areas were furnished with adequate seating and lighting available. Resident rooms appeared clean and had required furnishings. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mats were observed. Residents utilize the shower in the master bedroom which is occupied by resident. Guest bathroom is utilized by residents for toileting but not showering. LPA was unable to test water temperature as thermometer malfunctioned. Exterior tour conducted, all exits open and free of obstructions. The self-latching feature on one side gate was not working and needs maintenance to be brought into compliance.

Fire extinguishers located in the kitchen and in the hallway were purchased on 12/20/2023. Smoke detectors and carbon monoxide detectors tested and found to be operational during today’s inspection. Last fire drill conducted on 10/09/2024. LPA observed cleaning supplies secured in cabinet in the garage. Door leading to the garage is maintained locked. Facility has closed circuit camera (no audio) located in the dining room.

LPA reviewed staff and client records. Medications reviewed and observed to have original labels and be administered as prescribed. No deficiencies issued today.

LPA is requesting the following documents be submitted to the Fresno CCL office by 1/15/2025: Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A).

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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