Routine inspection·August 12, 2025

On 08/12/25 at 1PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with staff (ADM) and explained the purpose of the visit. ADM has a current RCFE certificate # 6068864740 which expires on 04/04/2026. LPA observed no residents living at the facility. 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 sanitizers were observed at the screening station. Emergency Disaster Plan, Personal rights 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 cabinets. Comfortable temperature is maintained at 78 deg F. 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. Fire extinguisher was observed fully charged and last inspected on 08/20/23. LPA observed the following deficiencies during visit: Expired fire extinguisher (last inspected 08/20/23) MIssing Infection Control plans Continued on next page, LIC 809-C 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 dates 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 file:  LIC500- Personnel Report LIC9020- Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans Exit interview conducted, appeal rights and a copy of this report provided .