• 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.

Records: Personnel Records were reviewed beginning at 11:13 a.m. Ten (10) Personnel files including the ED's file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order.

Resident Records were reviewed beginning at 12:42 p.m. Ten (10) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, Home Health records, Hospice records, PRN authorization letters, and current needs and services plan. All records were in order.

Facility Records: The facility uses Johnson Controls to conduct their annual fire alarm system inspection that was conducted on 04/03/2026 indicating a pass. LPA reviewed the quarterly inspections, testing and maintenance reports for the wet pipe and fire sprinkler system conducted on 03/04/2025, 05/27/2025, 08/25/2025 and 12/03/2025 indicating a pass in all areas. LPA reviewed smoke detector monthly test conducted the month of February 2026. The daily vehicle inspections, and annual Inspection report for both facility vehicles were reviewed. All records were in order.

Infection Control / Emergency disaster planning: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The emergency disaster plan was observed to be updated and reviewed on 02/24/2026. The last emergency disaster drill took place on 03/28/2026 at 12:30 a.m. and conducted quarterly covering all shifts and areas of emergency disasters. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard.

Interviews: During the initial visit on 04/06/26 and throughout today’s visit, LPA Mosley conducted brief resident and staff interviews. LPA interviewed nine (9) staff members, who demonstrated knowledge of resident rights, the various forms of abuse, and appropriate reporting procedures. LPA also conducted eleven (11) resident interviews. Resident interviews revealed no concerns noted or expressed at the time of the visit. Residents reported that a variety of activities are offered and provided, and that food substitutions are available upon request.

Report Continued on LIC 809-C PAGE 3...

Medication Audit: There are two (2) medication rooms / wellness centers in the facility. One on the first floor for assisted living and one on the second floor for memory care unit. Med Techs distribute medication at the appropriate times to residents in care. On the initial visit 04/06/2026 a Medication audit for ten (10) residents was conducted. Eight (8) in the Assisted Living Unit and two (2) in the Memory Care Unit. The following was observed. The medications were stored in the medication rooms in carts, both were locked and inaccessible to the residents. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed. During the medication review LPA observed four (4) out of ten (10) along with other residents with start dates missing on the centrally stored medication and destruction record which poses a potential health, safety, and personal rights risk to residents in care. LPA advised Resident Service Director (RSD) and Med Techs the importance of proper documentation to ensure medication audit and count is correct. RSD agreed to conduct an internal audit to ensure all records have the correct start date documented on the centrally stored medication and destruction record.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.