At 11:05am, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarm/carbon monoxide detectors are battery operated and were tested and observed to function properly. The fire extinguisher is located in the kitchen and was purchased on 10/17/2025. Facility uses the front door as the main emergency exit. Additionally there are exit doors in the living/dining room, bedroom# 5 and #6. Facility conducts quarterly fire/earthquake drills. The last fire/earthquake drill was conducted on 01/20/2026.

Kitchen: The kitchen appliances consisted of a refrigerator, oven and microwave. All appliances and kitchen surfaces were observed to be clean. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. There is a water filteration system in the kitchen. Knives and sharp objects were stored in the locked medication cabinet. Kitchen cleaning supplies and chemicals are being stored underneath the sink, in a locked cabinet.

Common Areas: These included the living room/dining room and dining area in the kitchen. A glass covered fireplace was observed in the living room, but the facility does not use the fireplace. The common areas were properly furnished with tables, sofas and chairs, appropriate with number of residents and staff. The auditory alarms on all exit doors were observed and tested to be functional. Facility is equipped with cameras in the common areas. Facility offers land line telephone, cable and wi-fi access for residents' use.

Continued on 809-C

• 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 designated for residents' use. One of the bathrooms is located inside bedroom #3. Both bathrooms have functional grab bars, non-skid mat, and fixtures. Hot water temperature in residents' bathrooms was measured 116.3 and 117.8 degrees Fahrenheit.

Surrounding Grounds/Garage: The pathways to front yard and backyard were clear of obstruction. No body of water was observed. There is a covered patio, outside the living room and is furnished with a table and chairs, appropriate for number of the residents. Facility has a detached garage which currently is used as storage space. The laundry machines are located inside the garage. LPA observed the laundry cleaning supplies, hazardous chemicals, detergents locked in the garage, inaccessible to residents in care. LPA observed two extra refrigerators in the garage, supplied with perishable food supplies. Non-perishable emergency food supplies were also kept in the garage.

Resident Files: LPA conducted a file review of all five (5) residents' records to ensure compliance of licensing forms.

Medications: There is a locked cabinet in the kitchen, used to store medications. LPA observed a complete first aid kit and first aid manual in the medication cabinet. Medication and Medication Records were reviewed for proper documentation. Medications were counted for all five (5) residents to ensure administration based on physician orders.

Staff Files: LPA also conducted a file review of three (3) staff records to ensure forms and training are up to date and in compliance with licensing forms.

Administrator Certificate was reviewed with expiration date of 01/22/2027. Liability insurance was reviewed with expiration date of 11/17/2026.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies were observed during the visit.

Exit Interview Conducted / A Copy of the Report provided to the Administrator.