Beginning at 10:25AM, the LPAs, along with 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:

BEDROOMS/RESTROOMS: The LPAs observed a random selection of ten (10) resident rooms, all of which contain private restrooms. All bedrooms were furnished appropriately with clean linens, furnishings and sufficient lighting. Separate carbon monoxide detectors and smoke detectors were tested in various resident rooms and all functioned properly at the time of the visit. Restrooms were clean, sanitary and in operating condition with grab bars and non-slip surfaces. Water temperature was tested in various resident restrooms and temperatures ranged from 113.0 to 117.1 degrees Fahrenheit.

COMMON SPACES: The facility contains multiple common areas throughout, including but not limited to: two (2) dining areas, three (3) activity/snack areas, common entry area, and a spa room. Walls and flooring were checked for cleanliness and good condition. Department required postings were found in the front lobby near the restrooms. Fire extinguishers were charged and serviced 09/11/2025.

EXTERIOR: The facility has several enclosed courtyards with appropriate outdoor seating for resident use. The swimming pool on the premises was observed to be locked.

Report Continued on LIC 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.

FILES: Record review began at 11:19AM. The LPAs reviewed a selection of five (5) staff files for documents including, but not limited to: health screening, TB test results, background clearance, and training records. All staff records reviewed were observed to be complete and in compliance with regulation at this time. The LPAs reviewed five (5) resident files for but not limited to: physician's report, needs and service appraisals, personal rights. All five (5) resident files reviewed contained all required documents.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: LPAs reviewed both the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facility conducts emergency disaster drills on each shift quarterly, with the last disaster drill documented on 02/19/2026. Fire system 5-year inspection was completed on 05/16/2024 and the annual inspection was completed on 08/05/2025. No defects were noted during either inspection.

MEDICATION REVIEW: Began at 01:47PM; LPA Huyhn, along with facility nurse, reviewed medications for five (5) residents. One resident (Resident #1-R1) did not have a centrally stored medication and destruction record (CSMDR), although R1's medications are being centrally stored by the facility. Nurse explained that the pharmacy sends the CSMDRs for the residents, however R1's prescriptions are filled at another pharmacy that does not provide a CSMDR. Administrator indicated that going forward, the facility will utilize Silverado's CSMDR, which meets the licensing requirements. All medications reviewed appeared to be administered as prescribed.

INTERVIEWS: Throughout the visit, LPAs interviewed five (5) staff and five (5) residents. No concerns were noted.

No deficiencies cited. Exit interview conducted and a copy of this report was provided.