Routine inspection·August 26, 2025

08/26/2025 09:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with Resident Care Coordinator (RCC) Carrie Breaux and explained the purpose of the visit. LPA Knight and the RCC toured the facility together to ensure the health and safety of residents in care. Assisted Living and Memory Care units were inspected. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas, patio areas and dining room. Staff and resident files were reviewed. All employees requiring background checks are cleared. All required postings are displayed within facility. Medication is locked in the medication room. Medication was reviewed. Common area was clean and in good repair. All rooms that were inspected had required furniture, bedding, and lighting. Bathrooms were clean and in good repair with the the exception of one common area bathroom that was out of order, and two resident showers that were soiled. Kitchen was clean and in good repair. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Fire extinguishers fully charged and inspected. Johnson Controls inspects and services the smoke detector and fire alarm system annually. Continued on LIC809-C Page 2 There are no pools/bodies of water on the premises. Last disaster drill was conducted in August 2025 which was a fire drill. The facility has been conducting fire drills every 3 months. Fire drills are conducted by shift. The following deficiencies were observed and are being being cited as a result of today’s inspection under Title 22. California Code of Regulations, (Title 22), is being cited on the attached LIC 809D. During file review LPA observed that 5 of 5 staff files did not have current first aid certificates. During the facility tour LPA observed the following physical plant deficiencies: common area restroom toilet not functioning, common area refrigerators in both the assisted living and memory care units have locks on the refrigerators, 1 of 8 resident rooms had a soiled shower curtain, 2 of 8 resident shower floors were soiled or stained, 1 of 8 resident rooms door handle is not operating properly, there is a soiled and broken recliner in memory care patio area that needs to be removed, siding on the west side of the memory care unit exterior is broken / worn and needs to be repaired and painted, exterior column in memory care patio area is worn / broken and needs to be repaired, replaced and painted, cyclone fence in front / east side of facility lot (surrounds ditch) has a broken section that needs to be repaired which poses a potential health, safety or personal rights risk to persons in care. An exit interview was conducted and copy of report was provided to Resident Care Coordinator Carrie Breaux.