Operation/Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pools or similar bodies of water. The facility has sufficient indoor and outdoor space for resident activities. The facility's outdoor activity space is shaded and enclosed with latching gates. Resident bedrooms were furnished with beds, bed linen, night stands, chairs, and sufficient lighting. Resident bathrooms were maintained clean, fixtures were operating properly, and equipped with non-skid mats. The hot water temperatures in the bathrooms measured at 106 degrees F. The facility is equipped with smoke detectors and carbon monoxide alarms, emergency supplies/water, fully charged fire extinguishers, first aid kit with manual, laundry equipment, hallway night light, and telephone service. The facility has posted in a common area Community Care Licensing complaint poster, Ombudsman poster, resident personal rights, activity schedule, sample menu, facility license, and emergency telephone numbers. Sharps and cleaning supplies were kept locked.

Food Service: Kitchen and dining areas were maintained clean. Non-perishable and perishable food supply was sufficient for number of residents in care. Cups, plates, and utensils were sufficient for number of residents in care.

• 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.

Health Related Services: Medications are centrally stored in a locked closet. LPA audited medications of four (4) residents. Review of Resident#1 (R1's) medications revealed that R1's did not have a refill of their prescribed over the counter daily medication. R1 had not been administered the medication since March 12, 2026. The Administrator stated that they will have staff pick-up R1's the medication today. File review reveals there was no documented of staff follow-up on the status of resident's medication. LPA also observed that 9 pills of Resident #2 (R2's) prescribed "one daily" medication had been dispensed since being refilled on March 14, 2026. Interviews with both the Administrator and staff reveal, that staff has been dispensing a new pill each time resident refused the medication. No documentation of resident medication refusal was observed.

Record Review: Resident files were reviewed for admissions agreements, physician’s reports, appraisals, needs and services plans. Staff files were reviewed had First Aid/CPR certifications, criminal record clearances, job training, health screenings, Administrator certification. The facility maintains facility’s insurance, infection control plan, disaster and emergency plan for review.

During today's visit, deficiencies were cited in accordance with Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted where reports (LIC809, LIC809C, LIC809D) were discussed and a copies provided with appeal rights to Caregiver Berumen.