Routine inspection·July 7, 2025

On 07/07/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with administrator Noralee Reyes and explained the purpose of today's visit. There are 2 staff present and 6 residents in care at time of visit. This facility is licensed for ages 60 years and over. All may be non-ambulatory. Hospice wavier on file. There is currently 1 resident on hospice at time of this inspection. LPA was allowed entry into the facility. This is a multilevel facility but the residents only reside on the main floor where the front door is located on the ground floor. The upper floor are rented out to private renters. Renters do not have access to the residents in the facility. Annual fees are current. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer adjacent to the stove top. Medications are also locked in a cabinet in the main living room area. Perishable and non-perishable food items are observed as in place. LPA advised that more canned goods to be in place. There are additional refrigerator/freezer in the garage areas which also carry additional food supplies. Laundry area is located in the garage and is in working condition during time of inspection. First aid kit is observed as complete with required items. LPA observed fire extinguisher in place and charged within operable range, smoke detector/carbon monoxide detectors are observed in place through out the facility, and central heating/cooling system. PPE and additional food supplies are observed as in place. Continued on next page. Page 2 Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted on 06/15/2025. Water temperature was measured at 110F. All resident rooms contain a half bath. Shower floor have non-skid mats when shower is in use in the common bathroom located in the main hallway. LPA observed rooms at random and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Resident linen supplies are observed as in place stored in a closet that is locked with cleaning supplies. LPA reviewed 4 resident files and also reviewed 3 staff files on this day. Per resident files reviewed they are current. Per staff files reviewed all files were current with training and CPR/First Aid. Client medications are inspected and are current including facility medication administration records. Administrator certificate is observed as current expiring on 09/24/2025. The following updated forms are requested to be submitted to CCLD by 07/14/2025 : • Copy of updated Administrator Certificates • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule No citations issued on this day. Report is reviewed with Noralee and a copy is provided.