The facility is licensed to serve six non-ambulatory residents and holds a hospice waiver for six. At the time of the visit, there were six residents in care, including one resident receiving hospice services.

LPA reviewed six resident files and three staff files. All files were found to contain the required documentation. The Administrator’s certificate is current and set to expire on June 15, 2027.

LPA Tea, accompanied by the Administrator, conducted a tour of the facility, including the physical plant, kitchen, and outdoor areas. The home consists of five resident bedrooms (one of which is shared), one staff room, two full bathrooms, two half bathrooms, a living room, dining room, and kitchen.

During the tour, LPA observed that smoke detectors and carbon monoxide detectors were present and operational in both common areas and resident bedrooms. The last disaster drill was conducted March 31, 2026. Resident bedrooms were appropriately furnished with required furniture, clean bed linens, and sufficient closet and drawer space to meet residents’ needs. Bathrooms were observed to be clean and in good repair. Toilets and faucets were functioning properly, grab bars were securely installed, and showers were free of mold and mildew. Water temperature measured between 115.3°F and 116.2°F, which is within the acceptable range. Adequate supplies of towels, toiletries, and personal hygiene items were available. Common areas were clean, well-maintained, and free of hazards, with unobstructed pathways. Cameras are installed in common areas for resident safety and do not include audio recording. The kitchen was inspected and found to be clean and organized. Perishable and non-perishable food supplies were adequately stocked. Sharps were observed to be secured in a locked cabinet, and toxic substances were stored in a

(Annual Inspection report continued on LIC809-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.

Medication storage and administration were reviewed. Medications are stored in a locked cabinet near the kitchen and are administered in accordance with physician’s orders. LPA conducted interviews with residents regarding their quality of care and with staff regarding services provided.

Based on observations and record reviews conducted during today’s visit, no deficiencies were cited in the areas inspected, in accordance with Title 22, Division 6 of the California Code of Regulations.

This report was reviewed with Administrator Sunita Chand. A copy of LIC 809, LIC 809-C, LIC 858, and LIC 859 was provided to the facility. Additionally, LPA provided a Legionnaires’ Disease Fact Sheet for informational and preventive purposes.