At 10:10AM, the LPA along with staff, 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.

KITCHEN: LPA inspected the kitchen/food service area at 10:10AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and nonperishable food. Food labels were inspected and checked for expiration dates. Knives and chemicals were locked and inaccessible in the cabinet under the sink. LPA observed emergency food supply.

BEDROOMS: There are three (3) bedrooms total; two (2) are shared-resident bedrooms, and one (1) is a single-resident room. LPA did not observe a staff bedroom. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. LPA observed half bed rails equipped for each resident. Upon record review, half rail orders for residents’ were missing.

RESTROOMS: There are two (2) restrooms total; one (1) is for resident use and one (1) is for staff use. Restrooms were clean, sanitary, and in operating condition with grab bars and slip-resistant surfaces. Hot water in resident restroom measured at 111.6 degrees F, which is within the required range.

Report 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.

OUTDOOR AREA/GARAGE: The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water. Passageways were free and clear from obstruction. LPA observed a locked garage containing a washer and dryer, additional refrigerator, and emergency water supply.

MEDICATION REVIEW: At 10:30AM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in the hallway closet. All medications including PRNs were labeled, stored, and locked inaccessible to residents. All medications reviewed were properly documented and accounted for; no errors observed.

RECORD REVIEW: Beginning at 12:43PM, LPA reviewed five (5) out of five (5) resident files and four (4) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training, first aid certification, and fingerprint clearance. LPA observed five (5) out of five (5) residents with half rails equipped on their beds and no half rails orders. Administrator stated she will obtain written orders for the half rails. Personnel files were complete and in compliance with Title 22 regulations at the time of the visit.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control policy and emergency disaster plan. Emergency disaster plan is updated annually as required and emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 06/27/2026. All documents reviewed were updated and in compliance.

The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Administrator was informed that failure to correct deficiency may result in civil penalties.

Exit interview was conducted. A copy of the report and appeal rights were provided.