Beginning at 09:35 AM the LPA, along with S1 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:

KITCHEN: 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 cabinet which contained resident medications, knives, and other sharp objects. LPA observed the kitchen to contain the facility’s washer and dryer.

BEDROOMS: There are four (4) bedrooms in the facility; two (2) are dual occupancy resident rooms, one (1) is a single occupancy resident room, and one (1) is a staff room. LPA and S1 toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #3 contained a direct exit to the outdoors of the facility. LPA observed one (1) resident bed to contain full bed rails.

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.

BATHROOMS: There is one (1) bathroom at the facility. It is designated as a shared/common resident bathroom. The resident bathroom was observed to be clean and was equipped with nonskid surfaces. Grab bars were observed in the resident shower and near the resident toilet. All were properly secured. The bathroom contained locked storage for resident grooming supplies and cleaning supplies. The water temperature was measured to be 118.6 degrees Fahrenheit, which is within the range required by regulation.

OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front yard of the facility; LPA observed clear passageways for emergency exit use. The facility has adequate seating outdoors for resident use but lacked appropriate shading. LPA observed a locked storage shed which contained cleaning and laundry chemicals. LPA observed an additional locked storage shed at the back of the property. LPA observed cameras located throughout the outdoors of the facility.

RECORD REVIEW: Record review began at 11:01 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained all required documentation and trainings. Five (5) resident files were reviewed. One (1) resident who was observed to have full bed rails installed was not enrolled in hospice care. LPA informed the Designee that bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

CONTINUED ON LIC 809C.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/10/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator.

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. LPA interviewed one (1) staff member, S1. The staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse.

During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, emergency disaster plan, and current liability insurance.

The Designee had to leave the facility at the time of the inspection but has designated S1 to sign this report on their behalf. This report was read to the Designee via telephone call. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.