Beginning at 10:45 A.M., the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

Smoke detector was tested at 11:20 A.M. and carbon monoxide detector was tested at 11:22 A.M. and both were functional at the time of the visit. Fire extinguisher was observed to be fully charged and last serviced on 08/12/2025. LPA observed a fire sprinkler system on site. The last documented annual inspection was conducted in 2023; however, Fire inspector R. Martinez explained that, because the facility is equipped with a residential sprinkler system, annual maintenance is not required.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The facility maintained a temperature of 72 degrees. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for residents use whenever needed.

Continued on LIC 809-C

• 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.

RESTROOMS: The LPA observed two (2) restrooms in the facility, both of which are common restrooms for shared resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and slip-resistant mats and surfaces. Hot water temperature was measured and was within the required range.

KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. LPA conducted a review of expiration dates on product labels. Medication and files were observed to be locked inside kitchen cabinets next to the fridge at the time of the visit. At 10:29 A.M. hot water measured 112.9 degrees Fahrenheit.

GARAGE/LAUNDRY ROOM: Adjacent to the kitchen is the facility's garage which remains unlocked. Inside the garage, the LPA observed a washer and dryer, cleaning supplies, personal grooming items, mobility devices, as well as knives and sharps. All potentially hazardous items were observed to be secured in a locked cabinet. Additionally, the facility stores its emergency food and emergency water supplies inside the garage.

OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for residents’ use. No bodies of water were observed at the time of the visit. Facility has two side gates; both were observed to be self-latching and closing with clear passageways for emergency exit use.

RECORD REVIEW: Between 11:46 A.M and 1:55 P.M., LPAs reviewed six (6) staff files and four (4) resident files. Files were reviewed for, but not limited to: Physician's Reports, Personal Rights, Admission Agreements, staff training records, health screenings, TB tests, and background clearance. All files reviewed were observed to be in compliance with regulation.

Continued on LIC 809-C

During today's visit, LPA gathered the following Personnel report (LIC 500), Resident Roster, a copy of the facility's liability insurance. Emergency disaster drills are conducted quarterly, with the last drill documented on 11/01/2025.

No citations issued. Exit interview conducted a copy of this report was provided.