The LPA and 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. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher expired on 06/12/2026. The Lincensee will provide proof of a new fire extinguisher by 07/30/2026. The LPA observed the required postings in the common area; however the LIC 9020 lacks the following information for one resident: Physician Contact and two residents lack Responsible Person Contact information. LIC 500 is missing Date Employed for each staff. The Emergency Disaster Plan was not posted, licensee agreed to post updated Emergency contact page by 07/30/2026. KITCHEN: Knives and are stored inaccessible to residents in cared. Kitchen appliances were in operable condition. The facility had insufficient supply of perishable and non-perishable food. The hot water temperature measured 114.8 degrees Fahrenheit. A bottle of cleaning supply was observed in an unlocked cabinet under the kitchen sink. BEDROOMS: There are three residents’ bedrooms. Bedrooms #1 and #2 are approved for bedridden residents and bedroom #3 for non-ambulatory. During the physical plant inspection, the LPA observed the following: Beds were not furnished appropriately with appropriate bedding and linens. All three bedrooms’ closet need a divider to separate the clothes for each resident.

• 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.

OUTDOOR AREA: There side fire exit gate was observed to be locked with a piece of wire from the outside preventing the exit from inside the facility, the licensee immediately removed the wire. No bodies of water noted. The washer and dryer are inaccessible in the garage area.

RECORDS: Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. Three out of three files were incomplete: missing signatures, Medical assessments, incomplete information, no or/ incomplete consent forms. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Two out of two staff files were missing the following information: LIC 501,503, 508, TB test. Three (3) files were missing the CPR/First Aid Certificate.

MEDICATIONS: Medications are centrally stored and locked in the kitchen area; medications are labeled and checked for expiration dates. The medications were not documented properly on the centrally stored medications and destruction record. The following errors were observed during the medication audit. Three(3) out of three (3) medication bottles (pills) did not match with the Centrally Stored and Destruction Record information.