BEDROOMS: LPA and the facility House Manager toured ten (10) randomly selected bedrooms; five (5) on the first floor and five (5) on the second floor. All rooms observed were properly furnished with sufficient lighting and clean linens and appropriate furnishings. All client bedrooms were observed to be clean and in relatively good repair.

BATHROOMS: All client rooms have an attached private bathroom. Additionally, there are common resident restrooms and staff restrooms located throughout the facility. All bathrooms inspected were observed to be clean and in relatively good repair The hot water temperature tested in all bathrooms and was observed to be within the range of 110.8 – 120.0 degrees Fahrenheit which is in compliance with regulation.

KITCHEN: LPA observed the kitchen to be inaccessible to clients. The kitchen area appeared to be clean and in good repair. All appliances and fixtures appeared to be functional. LPA observed a sufficient supply of two (2) days perishable and seven (7) days non-perishable food stored in the refrigerators and freezers.

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.

STAFF AREAS: This includes the medication/file room, the nurse’s station, and the basement of the facility. LPA observed the medication/file room to be located attached to the front desk and inaccessible to clients in care. The nurse’s station was observed to be monitored by staff and inaccessible to clients in care. LPA observed the entrance to the basement to be properly secured. LPA observed the basement to contain maintenance tools and supplies.

OUTDOOR AREAS: LPA observed a covered parking area attached to the back of the facility. LPA observed a courtyard at the back of the facility leading into the parking area to be equipped with patio furniture appropriate for outdoor use and adequate space for outdoor activities. LPA observed a front patio area at the facility entrance to be equipped with patio furniture appropriate for outdoor use. LPA observed clear passageways to all emergency exits.

RECORD REVIEW: Record review began at 10:50 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 the required documents and trainings. Five (5) resident files were reviewed. Four (4) resident files were observed to contain Appraisal Needs and Services Plans that were updated more than 12 months prior. LPA informed the House manager and Assistant Administrator Gabriela Chavez who agreed to update the appraisals for the clients and to send proof of the updated appraisals to Community Care Licensing Division (CCLD). CONTINUED ON LIC 809C.

MEDICATION REVIEW/CASH RESOURCE REVIEW: Medication review began at 12:19 PM. Medications for five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Cash resource review began at 01:10 PM. Cash resources were reviewed for five (5) residents. All cash resources observed were documented and stored properly. No deficiencies were observed during cash resource review.

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 03/05/2026. 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 administration.

INTERVIEWS: During today’s visit LPA interviewed five (5) clients. All clients interviewed stated that the staff members treat them well and are attentive to their needs. No clients interviewed had concerns with the facility. LPA interviewed five (5) staff members. All staff members interviewed were 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 and resident roster. Assistant Administrator agreed to email LPA a copy of the liability insurance no later than end of day 03/24/2026.

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.