Routine inspection·May 13, 2026

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:36 AM. LPA met with facility staff who contacted the facility Administrator Annie Osborn. The Administrator arrived to the facility at 01:03 PM. Entrance interview was conducted and the reason for the visit was explained. Beginning at 09:50 AM the LPA, along with facility staff #1 (S1) toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer which contained knives and other sharp objects. LPA observed a fire extinguisher mounted on the wall to be purchased on 05/08/2026. The kitchen contained a locked cabinet which contained facility files and locked under-sink storage which contained cleaning chemicals. LPA observed one (1) unlocked cabinet to contain supplements and Advil. LPA notified S1 who immediately secured the items. LPA observed one (1) unlocked cabinet to contain unsecured cigarettes. COMMON AREAS : This included the living room, hallway, and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a fireplace that was appropriately screened and contained no tools. LPA observed one (1) unsecured drawer in the living room to contain a bottle of Motrin. LPA notified S1 who immediately secured the item. The hallway was observed to contain a storage closet which contained extra linens for resident use. CONTINUED ON LIC 809C. COMMON AREAS CONT: The dining area was observed to be equipped with adequate seating for resident use. All furniture throughout the facility was observed to be clean and in good repair. The facility’s combination fire and carbon monoxide alarms were tested at 10:29 AM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. BEDROOMS : There are four (4) bedrooms in the facility; two (2) are single occupancy resident rooms and two (2) are dual occupancy resident rooms. LPA and S1 toured all four (4) resident bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedrooms #3 and #4 contain direct exits to the outdoors of the facility. BATHROOMS : There are two (2) bathrooms at the facility. One (1) designated as a private resident bathroom, and one (1) is designated as a shared/common resident bathroom. All resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured to be between 127.4 and 139.1 degrees Fahrenheit, which is outside of the range required by regulation. LPA observed the private resident bathroom to contain unsecured cleaning supplies in the under sink cabinet. LPA notified S1 who immediately secured the items. OUTDOOR SPACE: The facility has two (2) emergency exit gates located on either side of the facility; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed the backyard of the facility to contain an extra fridge/refrigerator. LPA observed this refrigerator to contain unsecured medications. LPA notified S1 who immediately secured the medications. LPA observed an unsecured lighter on the outdoor table and an unsecured bottle of floor cleaner on the side of the facility. LPA notified S1 who immediately secured the items. LPA observed one (1) window screen attached to bedroom #2 and the facility’s sliding door to contain tears in the screening material. GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. The garage contained an extra refrigerator, the facility’s washer and dryer, laundry chemicals, care supplies, and adequate emergency food and water supplies. CONTINUED ON LIC 809C. RECORD REVIEW: Record review began at 11:06 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Three (3) staff files were reviewed. LPA observed two (2) staff health screening forms to be blank and not completed by a physician. LPA observed one (1) staff member to be missing proof of a negative TB test. LPA observed one (1) staff file to be missing a completed LIC 501 (Personnel Record) and required information including the employee’s Social Security number, date of employment, educational background, past experience, etc. Five (5) resident files were observed. Four (4) resident files were observed to contain appraisal needs and services plans that were last updated more than twelve (12) months prior. MEDICATION REVIEW: Medication review began at 12:30 PM. Medications for three (3) of five (5) residents were observed. All medications were stored properly and were logged on their respective centrally stored medication and destruction record sheets. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/07/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. Both residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. LPA interviewed two (2) staff members. One (1) staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. One (1) staff member interviewed was knowledgeable on their roles and responsibilities but struggled to appropriately identify the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, emergency disaster plan, resident roster, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.