Starting at 09:18 a.m., the LPA along with the 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:

Kitchen: The LPA inspected the kitchen/food service area at approximately 9:20 a.m. Knives and sharps were observed locked and inaccessible in a kitchen drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. At 09:25 a.m., the hot water temperature was measured in the kitchen sink, and it measured at 110.5 degrees Fahrenheit.

Bedrooms: There are five (5) resident bedrooms. Four (4) bedrooms are designated as single occupancy, and one (1) bedroom are double occupancy. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. The LPA observed additional clean linens and towels for resident use. There is a staff bedroom on premises.

Report Continued on LIC 809C...

• 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.

Common Areas: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed the fire extinguisher to be new with a purchase date of 03/26/2025. Required postings were observed throughout the common space. Activities were observed in the living room and dining room. The LPA observed an adequate amount of emergency food and water. There is a working telephone on premises. Hardwired combination smoke and carbon monoxide detectors were tested and were functional at the time of the visit.

Bathroom: There are three (3) bathrooms in the facility. Two (2) bathrooms are designated for resident use and one (1) bathroom for staff only. Bathrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Beginning at 09:40 a.m., the LPA measured the hot water temperature in resident bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit.

Garage: The garage was locked and inaccessible to residents at the time of the visit.

Laundry Room: Washer and dryer were observed inside the laundry room by the garage. The LPA observed laundry detergents locked and inaccessible at the time of the visit.

Backyard: The backyard has a shaded area with patio furniture for residents’ use. All passageways were observed to be clear of any obstructions. There is one (1) side gate with latching mechanisms.

There is a pool which was fully enclosed at the time of the visit. At 09:45 a.m., the LPA observed a hand saw and two (2) five gallon paints in the backyard accessible to residents in care. The Administrator moved items in locked shed during the inspection.

Report Continued on LIC 809C...

Records: Beginning at 09:55 a.m., the LPA reviewed Resident Records and Personnel Records. Five (5) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. All files were complete.

Three (3) personnel files including the current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. Current Administrator’s Certificate is valid until 07/21/2027.

Record review and interviews revealed that Staff #1 (S1) has been working at this facility for at least thirty (30) days. The LPA reviewed the facility Guardian roster and discovered that S1 does have fingerprint clearance but is not associated with the facility. S1 left the premises immediately.

Medications: Medications review began at approximately 01:50 p.m. Medications are centrally stored in a cabinet adjacent to the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appeared to be given as prescribed at the time of the visit.

Infection Control / Emergency Disaster Planning: The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; the last one being a fire drill which was conducted on 01/07/2026.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809D.) Civil penalty issued in the amount of $500. Exit interview conducted, report and appeal rights were discussed, and a copy was provided.