Routine inspection (multi-day)·September 3, 2025

On 9/3/2025 at 9:30 am, Licensing Program Analysts (LPAs) Y. Brown and A. Gomez arrived unannounced to conduct the annual continuation that was conducted on 8/21/2025. LPAs met with Executive Director Evelyn Jenson and explained the purpose of the visit. The facility’s fire clearance was approved for one-hundred nineteen (119) total capacity. One-hundred fifteen may be non-ambulatory and eighty-four (84) may be ambulatory residents. Hospice waiver approved for eighteen (18). LPAs toured the facility including but not limited to a random sample of residents’ apartments, bathrooms, multiple activity rooms, kitchen, common area and outside courtyard. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 74 degrees F. LPA's returned to conduct file review. LPAs reviewed five (5) residents records. LPAs reviewed six (6) staff records. MAR was also reviewed. Report continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: On 8/21/2025 LPA's observed unlocked shed with filled gasoline tank. Personnel records were not readily available upon request and were observed incomplete. On 8/21/2025 LPA's observed that three (3) staff members had expired first aid certification. On 8/21/2025 LPA's observed that the food container lids were not properly placed and stored in the kitchen LPA's observed that R6 appraisal needs and services plans were not updated. On 8/21/2025 LPA's observed that the facilities call buttons were in disrepair LPA's observed that resident records were not readily available upon request and were incomplete. Two (2) technical violations were issued during the visit. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 09/10/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan - Reviewed Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.