Beginning at 10:45 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:

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. LPA observed a secured cabinet that contained resident medications. The kitchen contained the facility’s washer and dryer. LPA observed the door to the garage to be locked and inaccessible to clients in care. LPA observed a cameras covering the kitchen and common areas. LPA confirmed with the facility Administrator that audio is not recorded.

COMMON AREAS: This included the living room, hallway, and dining area. LPA observed all common areas of the facility to be clean and all furniture was observed to be in good repair. The living room contained a television, activities, and adequate seating for resident use. LPA observed the hallway closets to contain extra linens and care supplies. LPA observed the dining area to contain adequate seating for resident use. LPA observed fire extinguishers located in the dining area and hallway. Fire extinguishers were observed to be fully charged and purchased on 02/27/2026. The facility’s combination fire and carbon monoxide alarms, as well as the facility fire door, were tested at 01:26 PM and were functional at the time of the visit. CONT...

• 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.

INTERVIEWS: LPA interviewed two (2) residents and two (2) staff members. Both residents interviewed stated that the staff treat them well and are attentive to their needs. Both residents had no concerns with the facility. Both staff interviews were conducted with the assistance of the facility Administrator acting as a translator. Both staff members interviewed understood their roles and responsibilities, 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 LIC 500, resident roster, emergency disaster plan, and liability insurance.

No deficiencies were observed during today’s inspection. Exit interview conducted and copy of the report was issued.

BATHROOMS: There are four (4) bathrooms at the facility. Two (2) bathrooms are designated as private resident bathrooms, and two (2) bathrooms are designated as shared resident bathrooms. All 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 to be 109.4 degrees Fahrenheit, which is in compliance with regulation.

OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front yard; LPA observed clear passageways on either side of the facility for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed the backyard to contain ramps and handrails leading from the exits of resident rooms. All ramps were observed to be in good repair and all handrails were properly secured. LPA observed cameras located throughout the outdoors of the facility.

GARAGE: LPA observed the garage to be inaccessible to clients in care. The garage was observed to contain cleaning supplies, extra care supplies, emergency water supplies, file storage, and an extra refrigerator.

RECORD REVIEW: Record review began at 11:07 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 the required documents and trainings. Six (6) resident files were reviewed all resident files contained all required documentation and signatures. No deficiencies were observed during record review.

MEDICATION REVIEW: Medication review began at 12:53 PM. Medications for three (3) of six (6) 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. CONTINUED ON LIC 809C.