Common Areas: At approx 11:07 a.m., the LPA and AD began the physical plant tour. The common areas include the following on the first floor two (2) dining rooms, library and lounge. On the second and third floor LPA observed two (2) lounge areas. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. The fire extinguishers were fully charged and were last serviced on 02/14/2025. The LPA observed required postings throughout the common space. There is a dedicated area for the posting of required documents directly by the main entrance and hallway. The LPA observed the stairwells and they each had an emergency evacuation chair. Activity Rooms were observed and clean at the time of visit. The LPA observed an adequate supply of emergency food and water. The last fire inspection was completed on 06/10/25 and was found to be in compliance with Fire Code Regulations at the time of inspection. Emergency disaster drills conducted quarterly as per regulation; with the last one conducted on 06/24/25. Daily vehicle inspection list and California Highway Patrol Inspection report was reviewed for facility vehicles. All records were in order.

Report continued on LIC809-C PAGE 2...

• 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.

Interviews: From approx. 11:15 a.m. - 12:34 p.m. LPA conducted random interviews with eight (8) residents, ten (10) staff, and one (1) family visitor. Resident interviews revealed that no concerns were noted at the time of the visit. Staff interviews revealed that staff are knowledgeable in their job description, resident rights, different forms of abuse, and reporting procedures. Family visitor interview revealed that no concerns were noted at the time of the visit.

Bedrooms: Starting at 11:13 a.m. LPA inspected ten (10) randomly selected bedrooms throughout the (3) floors. The resident bedrooms were properly furnished with a bed, nightstand, and sufficient lighting. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets.

Restrooms: The resident restrooms appeared clean, sanitary and in operating condition with grab bars and slip-resistant surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared in the private rooms. The hot water was measured in all ten (10) randomly selected rooms and ranged from 114.1 – 117.7 degrees Fahrenheit all within the required range.

Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. Parking is available for residents and visitors.

Kitchen: The LPA inspected the kitchen/food service area at 12:20 p.m. Knives are stored and inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Dining room furniture was observed to be in good condition and appeared to be relatively clean. LPA observed resident having lunch in the dining room.

Report continued on LIC809-C PAGE 3...

Medication Audit: LPA conducted a medication review on six (6) randomly selected residents at approx. 12:38 p.m., The medications are centrally stored in the Medication Room located on the first floor. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. No errors observed during review.

Records: Resident Records and Personnel records were reviewed starting at approx. 1:02 p.m., eight (8) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files in order at the time of the visit. Nine (9) 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, and current needs and services plan. All files in order at the time of the visit.

LPA obtained the following documents – Census, Staff schedule, and updated Limited Liability insurance.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued.

Exit interview conducted. Copy of report provided.