INTERVIEWS: Starting at 10 a.m. three (3) staff and three (3) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit.

COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 12:05 p.m., hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 06/19/2026. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 05/18/2026 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. LPA observed surveillance cameras installed in the common areas of the facility. The Administrator presented the live monitoring screen to the LPA, confirming that all cameras were functioning properly and that none of them were equipped with audio capability. Report Continued on LIC 809-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.

BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff room. The staff rooms is kept locked at all times. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. During todays visit LPA observed an additional resident bedroom that was addressed in last years annual inspection detailing that they added a dry wall in the living room that created an additional bedroom after licensure. The Administrator presented evidence that the Application -LIC 200 form and the revised facility sketch reflecting the addition were submitted to CCLD on July 15, 2024, at 9:56 p.m. LPA communicated with Ventura County Fire Department (VCFD) inspector requesting an update regarding the inspection that was conducted. LPA was informed by the inspector that an initial inspection was conducted on 07/29/2025 and a subsequent visit was required. LPA has attempted to contact VCFD on multiple occasions regarding the subsequent visit however has been unsuccessful. Designee called Licensee representative Michael Rosales at 12:18 p.m. to inform LPA that a subsequent visit was conducted by VCFD and the facility was cleared however they are unable to access the documentation at the moment.

RESTROOMS: There are four (4) restrooms. Two (2) are designated as shared / common restrooms, one is designated at private resident restroom, and one (1) is designated as a staff restroom. Resident restrooms were observed to be equipped with slip resistant flooring. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured all resident restrooms and ranged between 107.6-110.5 degrees Fahrenheit, all within the required range

LAUNDRY: The laundry area is adjacent to the staff room and staff bathroom. The laundry area is an open concept with shelves above the washer and dryer. The laundry area is accessible through the kitchen area. Laundry detergent and chemicals are stored inaccessible in a large cabinet to the right of the washer and dryer. LPA observed an adequate amount of emergency water.

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

KITCHEN: The LPA inspected the kitchen/food service area at. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Two (2) refrigerators and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 107.6 degrees Fahrenheit. Cleaning supplies and other chemicals are kept in a locked under the sink inaccessible to residents in care. LPA observed an adequate amount of emergency food and water. LPA observed medications to be in a locked cabinet in the kitchen to the left upon entry from the main home entrance.

BACKYARD/GARAGE: The entire property is fenced. The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. There is a locked storage shed in the back yard inaccessible to residents. The garage is not accessible to residents.

Due to time constraints the LPA will return to complete the annual at a later date.

LPA will conduct the file review and medication audit.

Exit interview conducted. Copy of report reviewed and provided.