At approximately 12:30pm, LPA and the administrator conducted a tour of the inside, and outside of the facility to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. Smoke and Carbon monoxide detector observed operable during todays visit.

COMMON AREAS: The living room and dining room walls and flooring were checked for cleanliness and were observed to be in good condition. Furniture was observed to be clean, appropriate, and in good condition. Room temperature was recorded at 78 degrees Fahrenheit. Required postings observed on the main entrance hallway wall.

BEDROOM: The facility has six bedrooms with single occupancy, each bedroom has a private bathroom. Bedrooms were furnished appropriately with appropriate furnishings, bed linens, and sufficient lighting. Full rail observed on resident #5 Resident #5 is not on hospice at this time. BATHROOMS: Each of the six (6) bathrooms were observed to be clean; shower area was in clean condition with grab bars and a non-skid mat available. Towels for each resident were available for drying hands. Sufficient amount of hand soap, and paper products observed in each restroom. There were enough linens and towels for all residents.

KITCHEN: The appliances were observed to be in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Supply of emergency food observed in the pantry which is good for current residents and staff. Fire extinguisher observed in the kitchen (10/2025). Kitchen knives were stored inaccessible to residents in care.

• 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.

RECORDS: At approximately 1p.m., staff records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Required staff training not met. Administrator stated that she will ensure staff are appropriately trained and all required training records are kept on file and available for review. At approximately 2p.m., residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms.

MEDICATIONS: At approximately 4p.m., medications were reviewed; medications are centrally stored and locked in a closet located in the hallway and inaccessible to residents; medications are labeled and checked for expiration dates. two out six resident centrally stored medications and destruction record reviewed. During the medication audit it was observed that residents medications are set for 7-days in advance by licensee.

LPA requested copy of the following documents: updated LIC500 Personnel Report and liability insurance certificate be emailed for the office facility file.

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