Routine inspection·September 8, 2025

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the reason for the visit with Facility Designee Chris Williams. During this visit, LPA toured the facility inside & out. Resident rooms and common areas were clean, in good repair and contained the required equipment, furnishings and lighting. LPA observed required items in bathrooms with faucets delivering hot water. LPA observed hygiene items, paper products, towels, extra bedding, and linens which were stored and available for use. The kitchen was clean, with necessary items and appliances. LPA observed the required food supply. Medications are centrally stored in a hall closet. Cleaning/disinfecting supplies and chemicals are locked. Doors and passageways are unobstructed throughout the facility including outdoors. First aid kit contained required items. LPA walked outdoors to find the grounds well-kept with clear walkways. Fire extinguishers were found to be charged and serviced 1/9/24 by Jorgensen Fire Co. LPA conducted resident and staff file reviews and a medication audit. Infection Control and Emergency/Disaster procedures were reviewed. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D. An exit interview was conducted and Plan of Correction (POC) developed. A signed copy of this report and Appeal Rights were provided. LPA requested the following updated forms faxed to CCLD by 9/23/2025- Emergency Disaster Plan (Lic610D), Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Personnel Report (LIC 500), Client Roster (LIC 9020) and Proof of current Liability Coverage, Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402),