Beginning at 10:20 AM the LPA, along with the 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:

OUTDOOR SPACE: The facility had adequate shaded seating outdoors for resident use. LPA observed all emergency exits to be clear from obstructions. LPA observed two (2) emergency exit gates at the facility. LPA observed cameras located throughout the outdoors of the facility. All ramps were non-slippery and all railings were observed to be secured.

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 the kitchen to contain secured drawers which contained knives and other sharp objects. Additionally, LPA observed secured cabinets and a secured minifridge which contained resident medications.

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.

BEDROOMS: There are six (6) bedrooms in the facility all are single occupancy resident rooms. LPA and the Administrator toured all six (6) bedrooms. All resident rooms observed were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All bedrooms contained direct exits to the outdoors of the facility.

BATHROOMS: There are three (3) bathrooms at the facility, two (2) are shared, and one (1) is private. All resident bathrooms observed were clean and were equipped with nonskid surfaces. Grab bars were observed in all showers and near all toilets, all were properly secured. The water temperature was measured to be between 109.6 and 119.8 degrees Fahrenheit, which is in compliance with regulation.

RECORD REVIEW: Record review began at 10:45 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. Six (6) resident files were reviewed. All resident files contained all required documentation and signatures. LPA observed two (2) residents at the facility to be identified by their physician as being bedridden. LPA reviewed the facility’s fire clearance and observed that the facility was only cleared to retain one (1) bedridden resident. LPA notified the Administrator that retaining two (2) bedridden residents violated the facility’s fire clearance and that this is a zero-tolerance violation. LPA informed the Administrator that a civil penalty in the amount of $500 is being assessed on today’s date (04/21/2026) for a violation of the facility’s fire clearance. The Administrator expressed understanding and agreed to notify the fire department that they have a bedridden resident residing in a non-bedridden approved room. Five (5) staff files were reviewed. All staff filed contained all required documentation and trainings. CONTINUED ON LIC 809C.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last completed disaster drill was conducted on 03/18/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator.

INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had any concerns with the facility. LPA interviewed two (2) staff members. Both staff members interviewed were 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 LIC 500, resident roster, updated disaster plan, and current liability insurance.

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