LPA Tea reviewed six resident files and two staff files. All files contained the required documentation. The Administrator’s Certificate is current and expires on December 21, 2026.

LPA Tea, accompanied by care staff, toured the facility. The physical plant, food service areas, and first aid kit were inspected. The facility consists of six resident bedrooms, five full bathrooms, a staff medication room, living room, kitchen, dining area, and an attached garage. Smoke detectors and carbon monoxide detectors were observed in common areas and bedrooms and were operational.

Resident bedrooms were appropriately furnished with required furniture, adequate bed linens, and sufficient closet and drawer space to meet residents’ needs. Bathrooms were inspected and found to be clean and in good repair. Toilets and faucets were operational, grab bars were securely installed, and showers were free of mold and mildew. Water temperature measured approximately 116.9°F. An adequate supply of towels, toiletries, and personal hygiene items was available.

Common areas were clean, organized, and free of hazards, with unobstructed walkways and exits. The first aid kit was fully stocked with required supplies, including dressings, bandages, tweezers, a thermometer,

(Annual inspection report 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 an adequate supply of perishable and non-perishable food was observed. Kitchen appliances were operational at the time of the visit. Sharps were secured in a locked kitchen cabinet. Toxic substances were observed to be locked and inaccessible to residents in areas including beneath the kitchen sink and in the garage. Fire extinguishers throughout the facility were fully charged. The most recent fire drill was conducted on April 16, 2026. Emergency food and water supplies were observed to be adequately stocked in the garage.

Outdoor areas were also inspected. The backyard provides ample shaded seating for residents, and a barbecue grill is available for use. The exit gate on the right side of the home was observed to be self-latching and operational.

The facility provides activities tailored to residents’ preferences, abilities, and health conditions. Activities include games such as Jenga, arts and crafts, puzzles, walking, light exercise, and gardening. At the time of the visit, residents were observed watching television and participating in leisure activities.

LPA reviewed medication storage and administration practices. Medications are stored in a locked cart within the staff medication room and are administered in accordance with physician orders. LPA interviewed residents regarding their quality of care and spoke with staff regarding services provided.

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

An exit interview was conducted with Administrator Latoya Johnson. A copy of this report LIC 809, along with LIC 809-C, LIC 858, and LIC 859, was reviewed and provided to the facility. The LPA also provided the facility with a Legionnaires’ Disease Fact Sheet for informational and preventive purposes.