At 11:06AM, the LPA along with the House Manager, 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.

KITCHEN/GARAGE: LPA inspected the kitchen/food service area at 11:06AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and nonperishable food. Food labels were inspected and checked for expiration dates and food labels had expiration date clearly marked. Knives and chemicals were locked and inaccessible in kitchen drawer and cabinet under the sink. LPA observed a locked garage by the living room containing emergency food and water supply, additional refrigerator and freezer, washer and dryer, and supplies.

BEDROOMS: There are five (5) private resident bedrooms. There is one (1) staff bedroom which was observed locked. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, sufficient lighting, and equipped with functioning auditory exit alarms.

RESTROOMS: There are four (4) bathrooms; three (3) are attached to resident bedrooms and one (1) is a full bathroom in the hallway for residents, staff, and guests. LPA observed resident restrooms equipped with grab bars and slip-resistant surfaces. Hot water temperature was measured in all restrooms and were between 106.0-111.2 degrees F, which is within the required range. Report Continued on LIC 809-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.

OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water on the premises. There are a self-latching gates on the side passageways designated for an emergency exit. Passageways were free and clear from obstruction.

MEDICATION REVIEW: At 11:24AM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in the medication room accessed through the kitchen/laundry. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs were properly documented and logged. No errors observed during the medication review.

RECORD REVIEW: Beginning at 11:41AM, LPA reviewed four (4) out of four (4) resident files and three (3) personnel files for documents including but not limited to: medical records, resident Admission Agreement, TB test, staff training, first aid, and fingerprint clearance. LPA observed Staff #1 (S1) without a criminal record clearance. Administrator stated that S1 will not work at the facility until a background clearance is obtained and S1 is associated to the facility. All resident files were in order.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control policy and emergency disaster plan. Emergency disaster plan is updated annually as required and emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 05/28/2026. All documents reviewed were updated and in compliance.

The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Civil penalty was issued in the amount of $500 for criminal record clearance violation. Administrator was informed that failure to correct the deficiency may result in additional civil penalties.

Exit interview was conducted. A copy of the report and appeal rights were provided.