LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has an updated Infection Control Plan in place.

Operational Requirements: A hospice waiver for 15 residents has been approved. A fire clearance for 48 ambulatory, 32 non-ambulatory, of which 7 may be bedridden is in place. A hospice and Dementia waiver is in place. LPA observed the valid Surety Bond in place. LPA observed the Valid Liability Insurance in place. Fire and disaster drills were last conducted on 07/15/2025.

Physical Plant/Environment Safety: The facility consists of 48 resident rooms in a two-story main building and two (2) detached buildings, activity room, dining room, laundry area, two (2) courtyard patio areas, and one 2nd floor balcony. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. The fireplace is closed and inaccessible to residents. The facility has fully charged fire extinguishers. The Carbon Monoxide Detectors were tested and is operational. LPA inspected eight (8) residents' rooms and each resident bedroom has the required furniture such as the bed, bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition.

• 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.

Staffing: There are sufficient staff members to provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and are associated to the facility.

Personnel Records/Staff Training: LPA reviewed six (6) staff files which include: Personnel Record, health screening, TB test results, Employee Rights, valid First Aid / CPR/AED Training, ongoing staff and Dementia training. The administrator’s certificate is valid and expires on 04/25/2026.

Resident Rights-Information: Resident personal rights, complaint hotline information and visitors’ policy posters are posted in the 1st floor. Facility provides internet services to all residents and they have access to the facility phone.

Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar is posted.

Food Service: Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept clean and stored properly. Sufficient food supply is stored in the kitchen and pantry areas consisting of 2-day perishables, 7-day non-perishables, and emergency food supplies. Eight (8) residents are on modified diets. Physician orders are on file and special diet lists are kept in the kitchen area.

Incident Medical and Dental: LPA reviewed five (5) centrally stored resident medications which contain a 30-day supply of medications. Medical and dental transportation is provided. There were no issues.

Resident Records/Incident Reports: LPA reviewed five (5) resident files that include the face sheet, Identification and Emergency Information Form, Admission Agreements, Physician's Reports, Ambulatory Status, TB clearance, Physician's Orders, Preplacement Appraisal, Resident Appraisal, Centrally Stored Medication Destruction Record, and Personal Rights.

Residents with Special Health Needs: Four (4) residents receive hospice services and six (6) resident receives home health services. 10 residents have a Dementia diagnosis and are located in the 1st floor. Postural support physician orders are on file. Full bed rails for mobility assistance were observed in some resident rooms and LPA reviewed resident files with bed rail orders. No residents have prohibited health conditions.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the Administrator, Claudia Sanchez