At approximately 10:45 am, with the assistance of the Assistant Administrator, LPA took a tour of the physical plant. Required postings were observed in the hallway.

Facility is located side by side to Shalom Gardens II By SCH/745 North Harper Avenue, Los Angeles CA 90046. Both facilities are sharing the front yard and the backyard. There is a shared ramp in the backyard, leading to the front. Both the front door and the back exit are used during emergencies. Both entry and exit doors have a functional auditory alert when the doors open. There is a locked shed in the backyard for storage. There are ample seating in the backyard with patio furniture and umbrellas but the front yard furniture is located underneath a covered patio. There is no body of water present. Garage is located in the front and is used as storage and office space. There is a refrigerator with emergency food, water for both facilities, inside the garage. The laundry machines are inside the garage of Shalom Gardens II and are shared between both facilities. Both garages are separate from each other and are located in front of each house. There is no access from the inside to the other facility.

The smoke and carbon monoxide detectors are dual and inter-connected. The smoke/carbon monoxide detectors were tested and were observed to be functional. There are two fully charged fire extinguishers, both serviced on August 13, 2025, located in the kitchen and the other by the rear hallway exit. There are no cameras but facility offers land line telephone, wi-fi and internet for resident's use.

Continued on 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.

KITCHEN: The kitchen is equipped with two refrigerators (1 for staff use), stove/oven and a microwave. There were adequate supplies of dining ware to accommodate a maximum capacity of six (6) residents. Knives were observed to be locked in a kitchen drawer. Currently two (2) residents reside in the home and adequate supply of perishable and non-perishable food supplies were available. Cleaning supplies were locked underneath the sink.

BEDROOMS: There are five (5) bedrooms designated for client use. Currently bedroom number one (1) is shared. All the bedrooms are located next to each other, down the hallway and none of the bedrooms have exit doors. All bedrooms were furnished with beds, night-stands, chairs, dressers, bedding and linen.

BATHROOMS: The facility has one (1) small bathroom for staff use and all five (5) bedrooms have their own private bathrooms. All bathrooms were observed to have the proper fixtures, grab bars, non-skid mats. Bathrooms had adequate supply of linens and hygiene items. Hot water delivered in the bathrooms measured between 114.4-115.2 degrees Fahrenheit.

MEDICATIONS: LPA observed medications, first aid kit and first aid manual locked in a cabinet in the garage. One of the residents had their medication in the garage refrigerator, kept in a lockbox.

LPA reviewed the Infection Control Plan, The Emergency and Disaster Plan. Liability Insurance has expiration date of 09/22/2026.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.