Routine inspection·December 4, 2025

On 12/04/2025 at 09:30 AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at the Pepper Tree Assisted Living 3. LPA Calderon was allowed entry into the facility by Staff Ricarte Lapuz. The Facility is licensed to serve residents aged 60 and over, five non- ambulatory residents. Currently, there are two (2) residents residing in the facility. LPA Calderon explained to Staff Ricarte Lapuz the purpose of the one-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: Two (2) client service records, two (2) client medication records (MAR), two (2) staff records, and inspected the inside facility and outside grounds. The facility’s last fire drill was conducted on 11 /03/2025 . The two-story residential home consists of three (3) client bedrooms, one (1) client bathroom for Pepper Tree 3, living room, dining room, kitchen, staff room, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored or found on the premise grounds. The kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water Storage is in the patio/garage area. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of client’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies . Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 105 degrees Fahrenheit. Kitchen hot water temperature properly measured at 105 degrees Fahrenheit. Facility seven (5) Carbon Monoxide and seven (5) Smoke Detectors, hard-wired and connected, were tested and are working properly. Facility two (2) Fire Extinguisher was checked and found to be fully charged and accessible . All exit doors in the facility have alarm systems. The facility has a working landline/ telephone. All toxins and knives are locked/secured and inaccessible to clients. Medications are centrally stored and in a locked storage cabinet. Facility one (1) first aid kits are fully stocked with manuals being checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to clients. Two (2) client files were reviewed and found to be complete. LPA Calderon reviewed two (2) resident medications (MAR) and they were all found to be administered according to doctor's orders. Two (2) staff files were checked, and they have the required documents. LPA Calderon noted the Administrator Stephanie Klein Certification # 7019163740 expiration date of 05/15/2027 was valid at time of inspection. Commercial General Liability Policy #SRRG2025308 policy period from 07/18/2025 to 07/18/2026 underwritten by Sunland Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. All the required documents are posted in the facility in a clearly visible area. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe deficiencies therefore no citations were issued at this time. Annual Licensing Fee is CURRENT . An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Staff Ricarte Lapuz.