The LPA along with Administrator and staff toured the facility to ensure there are no health and safety hazards and the facility is in compliance with regulation. The following was observed:

Fire extinguisher was observed to be fully charged and last serviced 06/23/2026. Hardwired combination smoke and carbon monoxide detectors were tested and were functional at that time.

KITCHEN/FOOD SERVICE AREA: The facility has a sufficient supply of perishable and non-perishable foods, emergency food and water. Knives and sharp items were stored in a locked drawer. Cleaning supplies and disinfectants were stored underneath the locked kitchen sink and in the locked cabinet above the washer. The facility has a sufficient supply of plates, cups, and utensils.

RESIDENT BEDROOMS/BATHROOMS: The facility consists of 6 (six) bedrooms; 1 (one) is designated for staff use and 5 (five) are resident rooms. All 5 (five) bedrooms are furnished for resident use, containing all required furnishings and a sufficient supply of linens. The staff room remains locked. There are 2 (two) restrooms in the facility. 1 (one) is a shared resident bathroom and the other is for private resident bathroom in room #4. Both restrooms were observed to be clean and sanitary with grab bars and slip-resistant surfaces. Bathrooms had sufficient supply of hand soap, paper towels, and hygiene products for resident use. Hot water was tested in the common restroom at 118.4 F and the restroom in room #4 measured at 112.6 F 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 SPACE: The back yard area is enclosed, with one gate that was observed to be self-closing and latching. Although the latch has a built-in lock, the LPA reminded the Administrator that the gate cannot be locked due to fire safety and fire clearance. The backyard contains a shaded seating area and appropriate outdoor furnishings. There are no bodies of water on the premises. The backyard contains access to a locked garage. LPA observed the garage to contain extra cleaning supplies, storage, and paper goods.

RECORD REVIEW: The LPA reviewed 5 (five) resident files for items including but not limited to: physician’s report, Admission Agreement, personal rights, and needs and service appraisal. All resident records reviewed contained all required documents. The LPA reviewed 5 (five) staff files for documents including but not limited to: health screening, TB test results, and trainings. 2 of 5 (five) staff files reviewed had health screening and TB test result that were more than a year old. Best practices were discussed.

MEDICATIONS: Medications were observed to be locked and stored in compliance with regulation. The LPA reviewed medications for 2 (two) residents. During Resident 1's (R1's) audit the LPA observed that R1 was prescribed calcium carbonate-Vit D3 600 mg-10mcg but their medication box had oyster shell calcium with vitamin d3 500mg and Calcium citrate (630mg) with Vitamin D3 per serving, was prescribed Vitamin B12 and Vitamin B9 but had a bottle of B Complex #1, and had a bottle of MiraLax but no current order for it. Staff indicated that the resident arrived with the MiraLax from their previous location alongside the order summary report, however has not taken it. Staff were advised to contact R1's physician for an updated medication list. During R2's audit the LPA observed a bubble pack of Losartan, quantity of 15 (30 half tablets) that started on 7/17/26 and had the medication count of 14 tablets left.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.