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

LPA Tea reviewed four resident files and two staff files. All files were complete and contained the required documentation. The Administrator’s certificate is valid through July 19, 2027.

LPA Tea, accompanied by AD Ambion, conducted a tour of the facility. The physical plant includes six resident bedrooms, a staff room, six and a half bathrooms, a living room, family room, dining room, office area, kitchen, and an attached garage. Smoke detectors and carbon monoxide detectors were observed in common areas and bedrooms and were operational at the time of inspection.

Resident bedrooms were properly furnished with appropriate beds, linens, and sufficient storage space. Bathrooms were inspected and found to be in good condition, with functioning toilets and faucets, secure grab bars, and showers free of mold and mildew. Water temperature measured approximately 118°F. Adequate supplies of towels, toiletries, and personal hygiene items were available.

(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. Perishable and non-perishable food supplies were sufficient. Sharps were stored in a locked kitchen drawer, and cleaning supplies and other toxins were secured and inaccessible under the sink and in the garage. Fire extinguishers throughout the facility were fully charged. The most recent disaster drill was conducted on March 20, 2026.

Outdoor areas were also inspected. The backyard includes a shaded patio with ample seating for residents. There are two self-latching exit gates on either side of the home, both functioning properly. The outdoor space includes a garden area where residents may spend time and enjoy the environment. Emergency food and water supplies were observed in both the kitchen and garage.

Activities are provided based on residents’ preferences and health conditions, including options such as karaoke, board games, and light outdoor exercise. At the time of the visit, residents were observed resting comfortably in their rooms.

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

Based on observations made during today’s inspection, no deficiencies were cited in the areas evaluated in accordance with Title 22, Division 6 of the California Code of Regulations.

This report was reviewed with the facility. Copies of LIC809, LIC809-C, LIC858, and LIC859 were provided. The LPA also provided the facility with a Legionnaires’ Disease Fact Sheet for informational and preventive purposes.