Beginning at 01:46 PM, the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: There are five (5) bedrooms in the facility; three (3) are dual occupancy rooms, one (1) is a staff bedroom, and one (1) bedroom is unoccupied. LPA and facility Administrator toured all five (5) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on all facility exits and all were functioning at the time of inspection. The staff bedroom was observed to contain the facility’s emergency food and water supplies and was properly secured and inaccessible to clients in care.

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: This included the living room, dining room, and hallways. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a couch, a television, an office area for the Administrator, a locked storage cabinet which contained resident medication, and activities for resident use. LPA observed all required postings for the facility located on the living room wall. The dining room was observed to be clean and contained adequate seating for resident use. Fire extinguishers were observed throughout the facility, and all were fully charged and purchased on 03/16/2026. Fire alarms and fire doors were tested three (3) separate times between 03:21 PM and 03:24 PM. On the first test the fire door separating the living room from the resident rooms failed to disengage the magnetic latch and properly close the door. The Administrator informed LPA that if the AC was running the latch would not disengage. The Administrator turned off the facility’s AC and tested the fire alarm again. On the second test the fire door successfully disengaged the magnetic latch but due to friction between the bottom of the door and the floor the door failed to close and left the passageway to the resident rooms mostly open. On the third attempt the alarm was tested and the facility fire door successfully closed. LPA notified the Administrator that the fire door failing to close due to friction and the use of the facility’s AC constitutes a violation of the facility’s fire clearance. LPA informed the Administrator that this is a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (04/16/2026). The Administrator agreed to contact a licensed professional to service the facility’s fire door and to send proof of the completed service to Community Care Licensing division (CCLD). LPA observed cameras throughout the common areas of the facility. The Administrator confirmed that the cameras are not active and do not record audio.

CONTINUED ON LIC 809C.

KITCHEN/LAUNDRY: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured lock box which contained knives. LPA observed the kitchen refrigerator to contain expired milk, yoghurt, and dressing. LPA informed the Administrator who threw away the identified items and agreed to conduct an audit of the facility’s food supplies to ensure no additional expired items are located at the facility. LPA observed the laundry to be located adjacent to the kitchen. LPA observed secured cabinets in the laundry which contained detergents and extra cleaning supplies.

RECORD REVIEW: Record review began at 02:22 PM. Staff records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, and fingerprint clearance. Six (6) staff files were reviewed. LPA observed two (2) employees were hired at the facility on 04/07/2026. Staff are required to complete a total of forty (40) hours of training within the first year of employment and twenty (20) hours of this training must be completed before working independently with residents. LPA observed completed documentation of the forty (40) hours of training for the two (2) employees to be signed as completed on 04/07/2026. LPA asked the Administrator why forty (40) hours of training was documented as being completed on the same day. The Administrator stated that the trainings were completed across multiple days and the employees had signed their starting date on the training logs. LPA asked the Administrator what trainings were completed on the first day of employment.

CONTINUED ON LIC 809C.

INTERVIEWS: LPA interviewed two (2) residents. Both residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility.

Due to time constraints LPA will return at a later date to conduct interviews with staff, a resident file review, a medication review, a review of the facility’s emergency disaster plan and infection control plan, and to obtain copies of facility documents.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited and civil penalty assessed (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.