The physical plant was toured by LPA and Ian. The interior and exterior physical plant was inspected. There is only one entrance being utilized at the facility. A tour of the two story facility includes: All business offices and the kitchen, located on the first floor and second floor consist of resident rooms, bathrooms, common restrooms, common shower rooms, medication room, laundry room, storage room, activity/television room, beauty shop, library and a dining room. The kitchen was inspected. LPA observed kitchen equipment to be clean and in working condition. LPA observed the food supply stored at the facility. There was a sufficient perishable and non-perishable food supplies for residents in care. No pesticides or poisons were stored in the food areas. Sharps are stored in kitchen which is inaccessible to residents. Disinfectants and cleaning solution was located in the Janitor's closet. LPA observed random rooms: Room # 3,15,18 and 22 were inspected residents are on the second floor and all rooms have signal systems (tested and operable) and bathrooms. All selected bedrooms were furnished with required furniture. Some bedrooms have private bathrooms and some have shared bathrooms. Bathrooms were clean and sanitary and LPA tested the hot water was tested. Hot water tested and measured between 106.3-113.5 which is within Title 22 regulations. Laundry room is accessible to residents and laundry room contains pad locked lockers which have laundry products, disinfectants and cleaning solutions inaccessible to clients. LPA observed several storage rooms that were kept locked and maintained extra linen, towels, bedsheets, and blankets. (Continuation on LIC 809-C)

The front yard of the facility is well landscaped and has a leveled walkway to the entrance. The outdoor area was enclosed and no bodies of water were observed. Shaded area was provided by trees, and patio coverings.

All residents medications were centrally stored and locked in Medication Room and LPA reviewed four (4) resident's medication and medication record book, no deficiencies were observed.

LPA interviewed 4 residents and 2 staff as part as the annual inspection.

LPA reviewed 5 resident's files and 4 staff files, all had appropriate documentation. Administrator certificate is still pending for renewal, LPA was provided with proof of application submission. Documentation(s) collected LIC9214 Application for Administration Certification and ACS Application Pending list shows Administrator's application was received on 1/18/23. Applications are backup per ASCP Centralized Application Bureau.

Fire Drill conducted on: 5-12-23

Liability insurance expires: 10-01-23

Per California Code of Regulations, Title 22, no deficiencies were observed and cited during this visit. Exit interview held with Administrator Ian Baker and a copy of report given at the conclusion of the visit.