LPA Tea reviewed two resident files and one staff files. Resident and staff files contained the required documentation. The Administrator's Certificate expires on April 28, 2027 and July 7, 2027.

LPA Tea, accompanied by facility staff, toured the physical plant and inspected resident bedrooms and bathrooms, common areas, food service, medication storage, emergency supplies, and the first aid kit. The facility is a single-story home consisting of four resident bedrooms, two and a half bathrooms, a living room, dining room, kitchen, and attached garage.

LPA observed smoke and carbon monoxide detectors in the common areas and resident bedrooms to be operational. Resident bedrooms contained the required furniture, bed linens, and closet/drawer space to accommodate each resident comfortably. LPA observed bed rails being used on resident beds. Record reviewed reveal that there is no documentation supporting the use of bed rails. LPA reminded the facility that appropriate documentation/orders are required for the use of bed rails. Resident bathrooms were inspected. Toilets and faucets were operational, grab bars were secure, and the shower was free of mold and mildew. The hot water temperature measured 113.4 degrees Fahrenheit. Bath towels, toiletries, and personal hygiene supplies were adequately stocked at the time of the visit. Common areas were clean and free of hazards, and doorways and passageways were free of obstructions.

(Annual Inspection continued on LIC809C)

• 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.

LPA toured the exterior grounds and observed adequate outdoor seating and shaded areas. Two exit gates, located on each side of the facility, were self-latching and operational. LPA observed emergency food and water supplies stored in the garage. The facility's most recent disaster drill was conducted on September 25, 2026. The facility provides activities based on residents' interests and physical abilities. During the visit, LPA observed residents relaxing in their rooms.

LPA reviewed medication storage and administration. Medications were secured in a locked cabinet in the dining room area and were being administered as prescribed by physicians.

Based on observations and record review conducted during today's inspection, a deficiency is being cited pursuant to Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted with Administrator Priscilla Celis. A copy of this report, LIC809-D, LIC858, LIC859, and Appeal Rights were provided to the facility.