Beginning at 11:03 AM, the LPA, along with the Administrator 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:

COMMON AREAS: This included the living room and dining room. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained an appropriately screened fireplace, a television, and activities for resident use. The dining room was observed to be clean and contained adequate seating for resident use. Smoke detectors, fire doors, and carbon monoxide detectors were tested at 03:46 PM. During the test LPA observed the fire doors leading to resident bedrooms to fail to close when the fire alarm in the living room was activated. LPA tested the fire alarms in the kitchen and entryway and observed the fire doors closing properly. LPA retested the fire alarm in the living room at 03:48 PM and again at 03:52 PM and again observed the fire doors to fail to close. LPA notified the Administrator that the failure for the fire doors to close when the living room fire alarm was activated constituted a violation of the facility’s fire clearance. LPA notified the Administrator that this is a zero-tolerance violation and a civil penalty in the amount of $500 is being assessed on today’s date (08/03/2026).

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 at least quarterly and the last emergency disaster drill was conducted on 07/10/2026. 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) staff members and two (2) residents. The residents interviewed stated that staff treat them well and are attentive to their needs. The residents interviewed had no concerns with the facility. The staff members interviewed were knowledgeable on their roles and responsibilities, the resident rights, the different forms of abuse, and the appropriate reporting procedures for suspected abuse.

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

Pursuant to Title 22 of the CA Code of Regulations the following deficiencies were cited and civil penalty was assessed (refer to LIC 809-D). Exit interview was conducted. A copy of the report was issued, and appeal rights were provided.

• 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.

BEDROOMS: There are four (4) bedrooms in the facility; all are designated for resident. LPA and the Administrator toured all four (4) bedrooms in the facility. 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. Additionally, LPA observed an unsecured bottle of prescription medication in bedroom #3. LPA notified the Administrator who secured the medication at the time of the visit.

BATHROOMS: There are two (2) bathrooms at the facility, one (1) is designated as a shared resident bathroom and one (1) is designated as a private resident bathroom. Both bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed near all toilets and all were properly secured. The water temperature was measured to be between 107.3 and 107.8 degrees Fahrenheit, which is in compliance with regulation.

OUTDOOR SPACE/GARAGE: The facility had one (1) emergency exit gate located at the front entrance to the property; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. The garage was observed to be secured and contained an extra refrigerator, emergency water supplies, a washer and dryer, cleaning chemicals, and extra care supplies. LPA observed three (3) window screens attached to the private resident bedroom and bedroom #1 which contained tears in the screening material. LPA notified the Administrator who agreed to perform repairs to the identified screens.

RECORD REVIEW: Record review began at 11:33 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. Three (3) staff files were reviewed. All staff files contained the required documentation and trainings. Six (6) resident files were reviewed. All resident files reviewed contained all required documentation and signatures. No deficiencies were observed during record review. CONTINUED ON LIC 809C.