Routine inspection·August 13, 2025

On 08/13/25 at 1PM, Licensing Program Analysts (LPAs) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with staff (S1, S2) and spoke to administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA explained the purpose of the visit with staff. LPA observed administrator has a current certificate# 7001835740 which expires 11/23/25. At 1:10PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in the hallway closet. Comfortable temperature is maintained at 75 deg F. Hot water temperature was measured at 109 deg F. Fire extinguisher was observed last inspected on 03/13/25. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. LPA reviewed 2 staff and 5 resident files. Continued on next page, LIC 809-C LPA observed the following deficiency during visit: Two deadbolt locks on front door entrance Clorox wipes, Lysol Disinfectant spray and 3 air fresheners unlocked and unattended Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties . Updated copies of the following documents were obtained for facility files:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Exit interview conducted, appeal rights and a copy of this report provided