Beginning at 10:10am, the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed:

Bedrooms: There are three (3) bedrooms for resident use. All (3) bedrooms are designated as shared / double occupancy. Bedrooms were observed to be furnished appropriately and had sufficient lighting. Additional clean linens and towels were observed in a cabinet by the restroom.

Restrooms: There are two (2) restroom for resident use. Bathroom was clean and sanitary and in operating condition with non-skid surfaces and grab bars. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 10:14am, the hot water temperature was measured in resident bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit at the time of the visit.

Common Areas: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed a fire extinguisher to be fully charged with a purchase date of 08/01/2026. Required postings were observed throughout the common space. No hazards/obstructions observed inside or out.

Report Continued on LIC 809C...

Kitchen: The LPA inspected the kitchen/food service area at approximately 10:22am. Knives and sharps were observed in a locked drawer. Cleaning supplies were observed locked and inaccessible under the kitchen sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The hot water temperature was measured in the kitchen sink and it measured 116.1 degrees Fahrenheit.

Outdoors: There is an umbrella for shade and adequate furniture for resident use. Emergency passageway was observed to be clear of any obstructions. There is one (1) side gate with latching mechanisms. No bodies of water noted at the time of the visit.

Records: Record review began at approximately 10:40am.

Two (2) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, preplacement appraisals, appraisals, and current needs and services plan. All files were in order.

Three (3) personnel files were reviewed for, but not limited to: personnel records, health assessments with negative TB test results, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All personnel files were complete. The Administrator’s certificate is valid until 12/10/2027.

Medications: Medication review began at approximately 11:45am. Medications are centrally stored and kept in a locked cabinet by the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appear to be administered as prescribed at the time of the visit.

Emergency Disaster Planning: During today’s visit, the LPA reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; last disaster drill conducted on 07/02/2026.

No citations issued at this time. Exit interview conducted. A copy of the report was issued.

• 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.