Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to six (6) elderly residents, up to 6 may be non-ambulatory, of which, 1 may be bedridden. Bedroom #1 on the facility sketch was cleared for bedridden use. Facility has a hospice waiver for 4 residents. Facility does not have clearance for delayed egress and secured/locked perimeter. Currently, there are no residents who are bedridden nor receiving hospice services.

Upon arrival: LPA observed the room temperature to be at 74 degrees Fahrenheit. Present during this visit were five (5) residents in care with two (2) staff on duty.

Physical Inspection: Areas that were inspected include, but not limited to, the resident bedrooms, bathrooms, kitchen area, dining room, other common areas and outdoor areas.

LPA and staff inspected 6 of 6 resident bedrooms and 3 resident bathrooms. All bedrooms are single occupancy. Each bedroom has their own exit to the outside. Hot water temperature was measured in one of the bathrooms, and it was 109 degrees Fahrenheit.

In the kitchen area, LPA observed at least 7-day nonperishable and 2-day perishable food supplies. Knives/sharps and cleaning solutions were locked. Fire extinguishers observed and last serviced on February 23, 2026. Smoke and carbon monoxide detectors were observed throughout. Medication cabinet was observed to be locked and not accessible residents.

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• 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.

An advisory was provided, reminding the facility to ensure all staff are familiar with the location and operation of utility shut-off valves in case of emergency.

Record Reviews: Documents that were reviewed include, but not limited to, resident files, staff files, and other pertinent facility records.

Review of 3 of 5 resident file(s) was conducted, including but not limited to, review of Admission Agreement, Physician Reports, and Ambulatory Status. Medications were reviewed for same 3 residents. Advisory was provided to facility to ensure they only assist with medication administration with doctor’s orders and must only follow what is on the prescription order.

Review of 3 staff files included but not limited to background clearance, first aid/CPR certification, and training. No compliance issues were noted at this time.

Facility conducts quarterly Emergency Drills for fire, earthquake, power outage, and sheltering in place. Last drill was conducted on July 10, 2026.

Interviews: 1 staff member was interviewed; 2 residents were interviewed.

Documents Requested: LPA requested a copy of updated Liability Insurance, Personnel Records (LIC500), and Designation of Facility Responsibility (LIC308)to be emailed to Department

Per the California Code of Regulations, Title 22, Division 6, Chapter 8 and Health and Safety Code no deficiencies were cited. Advisories were provided.

Exit interview was conducted with AD. A copy of the report was provided.

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