LPA Tea reviewed six resident files and two staff files. During the file review, discrepancies were identified. One resident was missing required consent forms, and another resident’s appraisal documentation was incomplete. Staff records indicated that health screening forms were not updated to reflect current health status, and personnel record forms were missing. The Administrator’s certificate is valid through December 1, 2027.

LPA Tea, accompanied by staff, conducted a tour of the facility, including the physical plant, food service areas, and first aid supplies. The home consists of six resident bedrooms, one staff room, four full bathrooms, four half bathrooms, a living room, family room, dining room, kitchen, laundry room, and an attached garage. Smoke detectors and carbon monoxide detectors were observed to be operational in both common areas and resident bedrooms.

Resident bedrooms were adequately furnished with appropriate bedding, linens, and sufficient storage space (Annual Inspection continued on LIC809C)

• 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.

Common areas were clean, orderly, and free of hazards, with unobstructed pathways. The first aid kit was complete and included all required items. The kitchen was inspected, and both perishable and non-perishable food supplies were sufficient. Sharps were secured underneath the kitchen sink, and toxic substances were properly stored and inaccessible to residents in the laundry room. The kitchen fire extinguisher was fully charged, and all appliances were operational.

The most recent disaster drill was conducted on April 15, 2026. Outdoor areas were also inspected; the facility has two self-latching exit gates on either side of the home. The backyard includes shaded seating for residents. Emergency food and water supplies were observed in the garage.

The facility provides activities based on residents’ preferences and health conditions. Additionally, an activities provider visits weekly to facilitate light exercise and musical entertainment. During the visit, residents were observed having lunch.

Medication storage and administration were reviewed. Medications are stored in a locked cabinet in the laundry area and are being administered in accordance with physician orders. LPA Tea conducted interviews with residents regarding their quality of care and spoke with staff regarding services provided.

Based on today’s inspection, deficiencies are being cited in accordance with Title 22, Division 6 of the California Code of Regulations.

This report was reviewed with facility staff. A copy of this LIC 809, along with LIC 809-C, LIC 858, LIC 859, LIC 809-D, LIC 9102TV, and Appeal Rights, was provided and explained to the facility.