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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209142
Report Date: 09/02/2022
Date Signed: 09/02/2022 01:59:07 PM

Document Has Been Signed on 09/02/2022 01:59 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:OAKHURST BOARD AND CAREFACILITY NUMBER:
207209142
ADMINISTRATOR:SAECHAO, MAUNG LIAMFACILITY TYPE:
740
ADDRESS:41456 PAMELA PLACETELEPHONE:
(559) 293-3174
CITY:OAKHURSTSTATE: CAZIP CODE:
93644
CAPACITY: 11CENSUS: 8DATE:
09/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Licensee Josh McWealth via telephone, staff Maris Fehr and staff Dolores LagowTIME COMPLETED:
11:00 AM
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On 09/02/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and requested to meet with administrator. LPA met with Maris Fehr, Staff 1 (S1) . Licensee Josh McWealth was called and unable to attend meeting. LPA conducted tour with S1. Dolores Lagow, Staff 2 (S2) arrived later after tour. After tour S1 shift was over and left the facility. Seven residents were present during the inspection. LPA called and spoke with Licensee John McWealth via telephone and discuss report and inspection.

Upon entry facility staff was observed with no facial covering. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. Social distancing and cough etiquette postings observed.

At 09:19 AM, LPA and S1 observed five knives on kitchen counter unlocked. At 09:29 AM, LPA and S1 observed tools unlocked in the keys and batteries drawer in the kitchen. Food supply was checked and appeared to be an adequate supply. LPA checked residents’ locked medications. LPA observed fire extinguisher served date: 05/13/21. LPA observed 30 days PPE supplies. Cleaning supplies were stored and locked in laundry room. All resident’s room toured and observed to be adequately furnished and lit. LPA observed 1 shared residents’ bed to be at least 6 feet apart and six single occupant room. At 09:42 AM, LPA and S1 observed in master bathroom a tool unlocked on bathroom counter. All bathrooms are observed with securely fastened grab bars and non-skid mat. All bathrooms observed trash bin with lid. Hand washing posting observed by bathroom sinks.The exterior tour was conducted. Outside free o obstruction and debris. All resident records reviewed to have updated emergency contact information.

A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 9/8/22. The following updated forms were requested: Lic 308, Lic 309, Lic 500, Lic 610E, Lic 9282, Administrator Certificate and current liability insurance. Licensee was informed that as COVID-19 precautionary measure, this report and appeal rights will be provided via email. Signed report on file.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2022
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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Document Has Been Signed on 09/02/2022 01:59 PM - It Cannot Be Edited


Created By: Mai Yang On 09/02/2022 at 10:26 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: OAKHURST BOARD AND CARE
FACILITY NUMBER: 207209142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above when LPA and S1 observed at 09:19 AM five knives on kitchen counter unlocked. At 09:29 AM, LPA and S1 observed multiple tools unlock and stored in the keys and batteries drawer in the kitchen. At 09:42 AM, LPA and S1 observed a wrench on the counter in the master bathroom unlocked which are accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/03/2022
Plan of Correction
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Staff immediately removed knives and tools. Knives and tools were removed and stored under locked kitchen sink. POC cleared during visit.
Type A
Section Cited
CCR
87405(d)(2)
87405(d)(2) Administrator-Qualifications and Duties. The administrator shall have the knowledge of and ability to conform to applicable laws, rules and regulations.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, Fire Extinguisher has a service date of 05/13/21, which poses an immediate health and safety risk to the residents.
POC Due Date: 09/03/2022
Plan of Correction
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Fire extinguisher will be replaced or serviced with a current date. Proof of correction will be submitted to the CCL office by the 09/3/22.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Mai Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2022


LIC809 (FAS) - (06/04)
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