Beginning at 09:30 AM, the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

COMMON AREAS: This included the living room, hallway, and dining area. The living room was observed to be clean and in good repair and contained adequate seating for resident use. The living room contained an adequately screened fireplace and activities for resident use. LPA observed a fire extinguisher mounted in the living room to be fully charged and purchased on 01/26/2026. LPA observed a properly secured medication cart which contained resident medications and a mini refrigerator for medications requiring refrigeration. LPA observed one (1) unlocked hallway closet which contained extra linens and one (1) additional locked hallway closet which contained the facility’s washer and dryer along with cleaning and laundry chemicals. LPA observed the dining area to be clean and properly furnished at the time of the visit. The dining area contained a dining table with adequate seating for resident use. The facility’s combination fire and carbon monoxide alarms along with the facility’s fire door were tested at 09:51 AM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms.

KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer which contained knives and other sharp objects. Cont on LIC 809C.

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

BATHROOMS: There are two (2) bathrooms at the facility. One (1) bathroom is designated as private resident bathroom, and one (1) bathroom is designated as a shared resident bathroom. Both resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured between 108.3 and 112.3 degrees Fahrenheit, which is in compliance with regulation.

OUTDOOR SPACE: The facility has an emergency exit gate located in the front yard; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed the facility’s backyard to contain an extra refrigerator and two (2) storage sheds. One (1) shed contained care supplies and one (1) locked shed contained gardening supplies and cleaning chemicals.

RECORD REVIEW: Record review began at 10:00 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Three (3) staff files were reviewed. All staff files contained all required documentation and trainings. Five (5) resident files were reviewed. Four (4) resident files were observed to contain out of date Appraisal Needs and Services plans (ANS). LPA notified the Administrator that reappraisals shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition. The Administrator expressed understanding and completed updated ANS for the identified residents during the visit.

MEDICATION REVIEW: Medication review began at 11:10 AM. Medications for three (3) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Cont. on LIC 809C.

INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. Both residents had no concerns or recommendations for improvement for the facility. LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse.

During today’s visit LPA obtained a copy of the facility’s updated emergency disaster plan, LIC 500, resident roster, and liability insurance.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.