Routine inspection·November 25, 2025

On 11/25/25 at 3PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced annual required inspection. LPA met with Administrator (ADM) and explained the purpose of the visit. At 3:10PM, LPA toured the facility with including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of four (4) bedrooms and three and one-half (3 1/2) bathrooms. Swimming pool in back yard is surround and locked with metal gate. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA 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 not working. Residents’ bathrooms are equipped with grab bars. Carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 11/17/25. First aid kit was observed to be complete. At 3:30PM, the following deficiencies were observed during visit: Smell of urine in the dining area Broken towel holder, broken window blinds (3), back door leading to side yard is hard to open Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Continued on next page, LIC 9099-C LPA requested the following documents to be submitted to CCLD by 11/26/25 LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Exit interview conducted. Appeal rights and a copy of this report provided.