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

KITCHEN: The LPA inspected the kitchen/food service area at 10:11AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. Knives, sharps, and chemicals are stored locked and inaccessible to residents in care. The facility had a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for expiration dates; food labels had expiration date clearly marked. At 10:17AM, LPA observed six (6) expired food items (heavy whipping cream, chocolate milk, sour cream, milk, yogurt, ketchup, and mustard) that had expiration dates ranging from 01/2025-11/15/2025. Administrator and staff stated that the majority of the food items belonged to staff and discarded all expired items immediately.

BEDROOMS: There are three (3) shared bedrooms. LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. LPA observed the facility sketch on file to not match the physical plant. Bedroom #1 on the facility sketch contains an exit to the exterior, however, the room labeled Bedroom #3 had the direct exit. LPA and Administrator discussed the facility sketch errors and Administrator stated an updated and corrected facility sketch will be submitted to the Department.

Report Continued 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.

COMMON AREAS: At the time of the visit, living room and dining room furniture were observed to be in good condition. The facility maintained a comfortable temperature. The hardwired smoke detector(s) and carbon monoxide detector were tested at 10:33AM and all were operational at the time of the visit. The fire extinguisher was fully charged and last purchased on 09/18/2025. Laundry units are located in the hallway. Extra cleaning solutions, toxins, chemicals, and hazardous items were inaccessible and locked away in a locked hallway closet. LPA observed lighting in common areas to be dimly lit as seven (7) lights were not working. Administrator stated that the lights have been replaced multiple times but still do not work. Administrator stated they will repair the lights. The LPA observed required postings throughout the common space. There is a fireplace in the living room that was adequately screened. All auditory exit devices in common areas and bedrooms were functional and operating at the time of the visit.

OUTDOORS/GARAGE: The garage is kept locked at all times. The facility has an adequate supply of emergency food and water which was observed to be in good condition. Cleaning supplies are kept in the garage locked and inaccessible to residents in care. The facility has two (2) extra refrigerators in the garage with extra food for daily use. The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. Auditory alarms were observed functioning at the time of the visit. No bodies of water were noted at the time of the visit.

RECORD REVIEW: Beginning at 10:40AM, LPA reviewed five (5) out of five (5) resident and four (4) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. LPA observed two (2) residents with full bed rails without receiving hospice services and no written order in the residents’ files. LPA interviewed Resident #1 (R1) who had the full bed rail and R1 stated that the bed rail is kept up at night and restrains them which makes it difficult to get out of bed. LPA informed Administrator that full bed rails are only permitted for residents receiving hospice care and with a doctor’s order. Administrator removed the full bed rails during the visit. LPA also observed one (1) bed equipped with half bed rails but no written order in resident files. All personnel files were in order. Report Continued on LIC809-C.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency drills are conducted quarterly as required, with the last drill conducted on 10/25/2025.

The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Administrator was informed that failure to correct deficiencies may result in civil penalties.

Exit interview conducted. The report was reviewed, and a copy of the appeal rights and report were provided.