Beginning at 09:46AM, the LPA along with facility staff Aljon (Al) De Jesus conducted the physical plant tour. The common areas, kitchen area, resident bedrooms, bathrooms, and outdoor areas were toured to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: The facility contains 9 (nine) total bedrooms; 6 (six) are single-occupancy resident rooms and 3 (three) are designated as staff rooms. Staff rooms remain locked. All resident rooms were observed and were furnished appropriately; beds had clean linens and rooms had sufficient lighting. All direct exits were clear and no obstructions were noted.

RESTROOMS: Each resident room has a restroom and there is one common restroom in the hallway. Restrooms were clean and sanitary with grab bars and slip-resistant surfaces. Hot water temperature was measured in a sample of resident restrooms and measured within the required range. Restrooms were fully stocked with hand soap, paper towels and toilet paper.

COMMON SPACES: The LPA observed the living room area which was observed to be clean and properly furnished for resident use. Smoke detectors and carbon monoxide detectors were tested and operable at the time of the visit. Fire extinguishers were fully charged and serviced 3/19/2024. Licensee stated that the

• 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.

KITCHEN: Knives and chemicals are locked inaccessible to residents who may be at risk. Appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food.

GARAGE AND GROUNDS: The garage is locked and attached to the house. There is 1 (one) additional refrigerator and freezer in the garage with perishable items in good condition. Garage contains a laundry area, extra food supplies, emergency supplies, personal protective equipment and incontinence supplies. The backyard had furniture and a covered patio set for resident use. The side gate was self-latching. No bodies of water noted.

RECORD REVIEW: Record review began at 10:15AM. Resident records were reviewed for items including, but not limited to: physician's reports, appraisal needs and service plans, admission agreements and personal rights. 5 (five) resident records were reviewed during today's visit and all records were in order. Staff records were reviewed for, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and all other required training. All 4 (four) of 4 (four) staff files reviewed were in order.

MEDICATIONS: Medications review began at 11:30AM; medications are centrally stored and locked in a closet in the dining room. LPA observed medications for 2 (two) residents. Medications are labeled and checked for expiration dates, prescription numbers and date filled. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

EMERGENCY DISASTER PLAN/INFECTION CONTROL PLAN: During today's visit, LPA reviewed the facility's emergency disaster plan and infection control plan, both of which were observed to be complete and updated annually as required. The facility conducts emergency drills quarterly, with the last documented drill on 02/26/2025.

No deficiencies cited at this time. Exit interview conducted. A copy of the report provided.