Routine inspection·December 10, 2025

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year Visit and met with Administrator James Heinan. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA toured 6 resident living units. LPA observed each living unit had available bedding and clothing storage areas and working lights. The bathrooms had working lights and available soap and paper towels. LPA observed the water temperatures in the bathroom sinks to be between 111-119 F. LPA toured the outside area and found it to be clear of obstructions. LPA tested two out of two carbon monoxide detectors and found them to function properly when tested. During visit, staff were not able to test the smoke detection system and were not able to provide a copy of the last smoke detection system inspection report. The emergency disaster drill log indicates the last drill occurred on 10/01/2025. See LIC809-C page for more information. Page 1 of 2. LPA reviewed the Centrally Stored Medication and Destruction Record (CSMDR) for 5 residents. Resident R1's CMSDR was missing 2 medications and R2 was missing 1 medication. Staff entered the missing medications into the CMSDR during visit. LPA reviewed 5 resident records. R2's resident record was missing an Appraisal/Needs and Services Plan and R3's resident record was missing an Admission Agreement. LPA reviewed 5 staff records. 4 out of 5 staff were missing a current first aid certification. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D pages for more information. An Advisory Note was issued. See LIC9102 for more information. LPA Marrufo requests that the following documents be updated and copies sent to the department by 12/17/2025: LIC500 Personnel Report LIC308 Designation of Administrative Responsibility Liability Insurance LIC610 Emergency Disaster Plan This report was reviewed with Carolyn Heinan and a copy of this report and appeal rights were provided. Page 2 of 2.