The facility consisted of one building with two floors for assisted living units. The Manager informed the LPA that the facility had 41 residents in care at the time.

LPA initiated a walk-through of the facility, accompanied by the manager.

LPA inspected randomly selected five (5) resident rooms. The rooms were found to be clean, well-lit, and equipped with the required furniture. LPA inspected the private bathrooms in random rooms. The bathrooms contained soap, grab bars, towels, a trash can, and non-slip flooring. The hot water temperature at the sink faucets measured between 112.8°F and 116.6°F.

LPA inspected the main food serving area and dining area and found it clean. All meals at the facility are prepared in a third party kitchen, Morrison Living, which is located next to the facility. The meals are brought from Morrison Living kitchen to the facility and are served in the dining area at the facility. The refrigerator was observed to contain milk, creamers, juices, yogurt, bread, and butter. The freezer was observed to contain ice cream. Cereal boxes and fresh fruits were observed on a table in the serving area. A weekly dining menu and an alternate fixed menu was available to residents.

LPA inspected the fire extinguishers mounted on the hallway walls and found them fully charged, with the last service tag dated January 30, 2025.

Continued on LIC809-C

• 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.

LPA inspected an auditorium on the first floor and observed 6 residents participating in workout activities. The auditorium and souyer room on the second room are used for resident activities. Activity calendar was posted one month is advance for the residents. All common areas were free from obstructions, and hallways were well-lit.

LPA toured the outside courtyard and patio areas and found passageways in good condition, free of obstructions, and without any blocking or tripping hazards. These areas had patio tables, chairs, and shaded area/umbrellas for residents’ use. No accessible bodies of water or hazards were observed.

LPA observed and inspected a locked centrally stored medication cart in the medication room. Medications were organized separately for each resident. Narcotics were locked. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete.

LPA reviewed six (6) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. 5 of 5 residents didn't not receive routine annual medical assessment. LPA observed that 6 of 6 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 6 of 6 staff members were associated with the facility.

LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 05/15/2025.

The following updated forms are requested to be submitted to CCLD by 08/25/2025:

1) LIC 500: Personnel Report

2) LIC 308: Designation of Facility Responsibility

Continued on LIC809-C

4) Administrator Certificate(s)

No deficiencies were cited during today's visit. An Advisory note was given.

An exit interview was conducted with the Manager. A copy of this report was provided to the Manager,Anahi McKane, whose signature on this form confirms receipt of the report.