Routine inspection·January 12, 2026

On 1/12/2026 at 1:00 PM, Licensing Program Analysts (LPAs) A. Gomez and Y Brown arrived unannounced to continue the Required 1 Year Annual inspection. Upon arrival, LPA was greeted by Caregiver, Ulanda Mitchell and explained the purpose of the visit. Administrator arrived at 2:00PM. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 113.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were not locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 01/28/2025. Emergency Disaster Plan was last posted on 01/01/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on December 2025. At 1:40pm, LPA reviewed 2 residents records. At 2:30 pm, LPA reviewed 2 staff records. REPORT CONTINUES ON LIC 809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPAs observed a pair of scissors with a blue handle located in the kitchen on top of the microwave (Repeat Violation) LPAs observed Vicks formula 44DM cough syrup on R1's bedside table Facility not properly documenting the use of R1's PRN cough syrup R2's appraisal of needs and services is incomplete S2's File incomplete LPAs observed the administrator in poor health (leg injury that they state requires surgery) that could impair their ability to provide care Facility did not have planned activities. LPAs observed PUB475 is the incorrect size Based on observations LPAs are requesting that R2 get an updated physicians report after visiting the doctor. ***Civil Penalties assessed in the amount of $250 for repeat violations*** Updated copies of the following documents were requested for facility file and are to be mailed to CCL by 1/21/2026: LIC 500 Personnel Report Liability Insurance Current Administrator’s Certificate Emergency Distaster Plan LIC610E 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.