Post-licensing visit·April 24, 2026

On April 24, 2026, Licensing Program Analyst, Arvin Villanueva (LPA) arrived at this facility unannounced to conduct a case management visit. LPA met with staff on duty, Kirk Campbell (S1), and stated the purpose of the visit. S1 notified the assistant administrator who he identified as "John" but S1 stated he never answered or responded throughout this visit. When LPA asked if S1 know or seen Veniana Banuve, S1 stated he has not since he started working at this facility. S1 stated he only met "John" and "Kim" and identified them as "management." "John" arrived at 3:00 pm. Present during this visit were 5 residents in care with one staff on duty (S1). Fire door was observed to be closed upon arrival. The purpose of this visit is to return the resident (R1), files and staff files that were removed on April 23, 2026, for the purpose of copying files at the Regional Office. Files were handed to S1 during this visit. Additionally, the purpose of this visit is to continue the post-licensing inspection that was initiated on April 23, 2026. Physical Inspection : Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA and S1 inspected 3 of 5 resident bedrooms and 2 of 2 bathrooms. Hot water temperature was taken in both bathroom – temperature was between 150 and 151 degrees Fahrenheit. In the kitchen, LPA observed 3 kinds of fruits (half a bag of apples, nearly empty container of blue berries, and one whole avocado). LPA did not observe fresh vegetables in the refrigerator. Per review of the sample menu provided by S1, vegetables are included such as green salad, for lunch and cabbage slaw for dinner, as example. {1 of 2} One fire extinguisher was observed in the kitchen area and was last inspected on March 18, 2026. The cabinet under the kitchen sink where they keep cleaning chemicals and sharps was observed to be accessible as evidenced by being secured by a plastic “child proof locking device” but can be unlocked without a key. Per S1, they use this device during the day but uses a lock with a key at night. LPA informed S1 that dangerous items need to be always locked and not accessible to residents in care. Dishwasher was not working during this visit. S1 stated a repair request has been initiated but unsure when it will be done. The garage is not accessible to residents in care, and it is kept locked and can be accessed with a key. The sliding door at the living room/kitchen area leading to the backyard was difficult to slide open. Outdoor area was inspected. S1 was unable to correctly identify, locate. and know how to operate each of the shut off valves. Per S1, he was not oriented on these. Walkway to the exit gate was obstructed by a wood bookshelf/cabinet, a white shower chair, and some type of green ceramic plant pot. Someone who uses a wheelchair would not be able to get through immediately during an emergency. Based on today’s visit, deficiencies are being cited and advisories were provided. Exit interview was conducted with with Veniana over the phone and gave permission to S1 to sign this report. A copy of this report and appeal rights were provided. {2 of 2}