This facility is conveniently located near highway 41 in Fresno, California. The grounds and interior are well maintained and clean. Most rooms are shared by two or three patients, however there are private rooms available. The front door is monitored, with an automatic locking feature, and visitors and staff are "buzzed" in to enter. Visitors are required to sign in at the reception desk. Along with dining areas, physical therapy rooms, etc., there are sitting areas, and a television room with couches and visiting. There is also a courtyard area, and a large outside area in back that is fenced. There is grass, trees, benches and tables. The perimeter is well fenced for patient protection. Staff checks the area regularly, assuring that patients are safe. Certain patients are accompanied if they want to go out. In general, staff is kind and accommodating to both patients and visitors. We have found that staff is very thorough about observation, tracking and logging of medications, meals, personal habits, and any general day to day notes that help monitor patients. Although shared rooms are minimal, with only a small closet space, shared toilet room, and one nightstand, patients' families are allowed to provide TVs, radios, photos, a special bedspread/blanket, etc. Clothing is changed daily, or more often if required, and is kept laundered and clean. Bedding is likewise kept clean, and rooms in general are well maintained, neat and clean. There are a variety of meal options available, and each individual has his/her own meal "plan" for issues such as allergies, food textures, etc. Although the administration and staff strive to constantly improve, we did have a couple of situations in the past where we believe medications caused some difficulty on behalf of our family member. We understand that she can be difficult, and do not deny the need for certain medications. However in the process of "balancing" out medications, our family member did have some difficulty staying awake. This caused her to eat very little, and she lost weight that was cause for concern. In attempting to improve her dietary intake, she was placed on pureed food diet, which she doesn't like. Now that medications are balanced, and she has adjusted to living at a facility she is doing very well. She was still on puree though, and a request was made and subsequently granted to place her back on solid foods, which she seems very happy about. So a small amount of staff following up on those details would be nice, but this is also something that we, as family should expect to keep an eye on also. UTIs are an ongoing problem, but this was an issue before her living at Elim. Staff does a fairly good job monitoring this, and is pretty good at noticing changes in behavior that may indicate infection, and therefore testing is completed and meds administered if needed. As with any place (not just care facilities) some staff is better than others. While we haven't found any staff that is what we could consider "bad," or reckless, there are a few individuals who obviously care about the patients as individuals and go above and beyond. You can see that they have affection for the patients and truly care about their well being. In general, we have been very pleased with this facility. If we could have mom at home, we would. But because she gets combative and can be very difficult, we found the need to have her in a facility. Overall, we are very pleased with the level of care mom gets, and would recommend Elim to others.