Correction check·September 11, 2025

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 07/18/2025 and 08/05/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87464(f)(1) pertaining to Basic Services has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87355(e)(2) pertaining to Background Clearance has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87204 pertaining to Limitations- Capacity and Ambulatory Status has been cleared. Resident has been moved to the first floor. Licensee has complied with the terms of the POC. *Deficiency cited under H & S Code 1569.17(c)(1)(A) pertaining to Finger Print Clearance has been cleared. Licensee has provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87303(c) pertaining to Window Screens has been cleared. Window screen has been repaired. Licensee has complied with the terms of the POC. CONTINUED ON LIC 809C DATED 09/11/2025 *Deficiency cited under Title 22 Regulation 87608(a)(3) pertaining to Postural Supports has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under H & S Code 1569.625(b)(2) pertaining to Required Training has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under H & S Code 1569.50(a)(3) pertaining to Conduct Inimical has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87405(a) pertaining to Administrator Qualifications has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87411 pertaining to Health Screen/ TB has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. Licensee has been advised to maintain compliance on all items previously cited. Exit interview conducted and a copy of this report was left at the facility.