Beginning at 10:01 a.m., 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:

Kitchen: The LPA inspected the kitchen/food service area at approximately 10:12 a.m. Knives and sharps were observed in a locked drawer at the time of the visit. 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 LPA observed an adequate amount of emergency food and water. At 10:13 a.m., the hot water temperature was measured in the kitchen sink at it measured at 112.8 degrees Fahrenheit.

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 fireplace in the living room; adequately covered.

Report Continued to LIC 809…

• 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.

The LPA observed several fire extinguishers to be fully charged with a purchase date of 04/01/2026. Required postings were observed throughout the common space. There is a working telephone on premises. First aid kit was observed to be complete. No hazards/obstructions observed inside or out.

Restrooms: There are six (6) restrooms for resident use. Each bedroom has its own bathroom. Bathrooms were 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 10:04am, the hot water temperature was measured in resident bathrooms, and they measured between 112.6 and 113.7 degrees Fahrenheit which is within the required range of 105 – 120 degrees Fahrenheit.

Bedrooms: There are six (6) bedrooms for resident use. Bedrooms are designated as private / single bedrooms. Bedrooms were observed to be furnished appropriately and had sufficient lighting. Additional clean linens and towels were observed in a closet by the hallway. Staff bedroom observed on premises.

Utility Room: Detergents and cleaning supplies were observed locked and inaccessible to residents in care at the time of the visit. The LPA observed an additional refrigerator and freezer in good condition.

Laundry Room: The LPA observed a washer and dryer in good condition. Detergents and toxins were observed locked at the time of the visit.

Outdoors: The backyard and front yard have a shaded area with adequate furniture for resident use. Emergency passageway was observed to be clear of any obstructions. There is a side gate with latching mechanisms for emergency purposes. No bodies of water noted at the time of the visit

Records: Record review began at approximately 10:30am.

Six (6) 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.

Report Continued on LIC 809C...

Five (5) personnel files were reviewed for, but not limited to: personnel record, health assessment with negative TB test results, criminal record clearance, first aid/CPR training, and the appropriate yearly training. All personnel files were complete. The Administrator’s certificate is valid until 07/21/2027.

During today’s visit, the LPA conducted interviews with three (3) residents and no concerns were noted.

Medications: The LPA conducted a medication review for three (3) residents. Medications are centrally stored and kept in a locked cabinet adjacent to the dining room. 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 05/02/2026.

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