The facility is licensed to serve six non-ambulatory residents, with an approved hospice waiver for all six residents and allowance for one bedridden resident in Bedroom #1. At the time of the visit, the facility was operating at full capacity with six residents, three of whom were receiving hospice care.

During the visit, LPA Tea toured the facility alongside staff and the Administrator. The home consists of five resident bedrooms, including one shared room, two staff rooms, two and a half bathrooms, a living room, family room, dining area, kitchen, and an attached garage. Throughout the inspection, the facility was observed to be clean, organized, and free of hazards. Pathways and exits were clear and unobstructed.

Safety features were checked and found to be in good working condition. Smoke detectors and carbon monoxide detectors were operational throughout the home, and fire extinguishers were fully charged. Documentation showed that the last fire drill was conducted on January 13, 2026.

Resident bedrooms were adequately furnished with appropriate beds, clean linens, and sufficient storage space to meet residents’ needs. Bathrooms were clean and well maintained, with functioning toilets and faucets, secure grab bars, and showers free of mold or mildew. Water temperature was measured between 107.1 and 111.4 degrees Fahrenheit, which is within the required range. Towels, toiletries, and personal

(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.

The kitchen was inspected and found to be clean and fully operational. The facility maintained an adequate supply of both perishable and non-perishable food. Emergency food and water supplies were also observed and stored in a locked closet near the kitchen. Sharps were secured in a locked drawer, and cleaning supplies and other toxic substances were properly locked and kept inaccessible to residents. The first aid kit was complete and contained all required items.

The outdoor area was also inspected and found to be safe and accessible. There was ample shaded seating available for residents, and the exit gate on the side of the home was self-latching and functioning properly. An unused pool in the backyard was secured with a locked gate. The facility provides activities based on residents’ preferences. During the visit, LPA observed residents participating in light exercise. Staff indicated that residents also enjoy reading and engaging in other activities of their choosing.

LPA reviewed six resident files and two staff files. All files were found to contain the required documentation. The Administrator’s certificate is current and valid through September 27, 2026.

Medication storage and administration practices were also reviewed. Medications were securely stored in a locked cabinet near the kitchen and were being administered in accordance with physician orders. LPA conducted interviews with residents and staff during the visit. Residents indicated they were satisfied with the care they receive, and staff demonstrated knowledge of their duties and responsibilities.

Based on observations made and records reviewed 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.

An exit interview was conducted with Administrator Geraldine Doan. Copies of LIC 809, LIC 809-C, LIC 858, and LIC 859 were reviewed and provided to the facility. Additionally, a Legionnaires’ Disease Fact Sheet was given for informational and preventive purposes.