Routine inspection·November 18, 2025

On 11/18/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with the administrator Anna Allas and explained the purpose of today's visit. There are currently 134 residents in the facility during this inspection and multiple staff through out the facility. This is a multi-level facility, Age range 60 years and above. Hospice waiver for 10 residents with a total care addendum has been approved. Fire clearance for 150 non-ambulatory residents has been approved. There are 10 residents under hospice care as of today's visit. The physical plant was toured inside and outside of the facility to ensure the safety of the clients. Large dining room is clean and organized for residents. Lunch is being served during today's inspection. The facility also has a bistro adjacent to the main dining room. Dining menu and activities calendar posted. Per facility, menu's for the month and week are communicated via flyers in resident mail cubby and email for residents and family. LPA observed the facility kitchen which is clean and observed that all appliances are in good repair. Per staff, all appliances are in working condition. Knives are stored and locked and secured in the kitchen. Perishable and non-perishable food supplies are observed as in place. Kitchen grade fire extinguisher is observed as in place and with an inspection date of 06/04/2025. Canned food supplies and dried food supplies are stored within the kitchen. Cleaning substances and dish washing chemicals are properly stored and labeled. Per kitchen director, and in service training was conducted around 11/04/2025 with the facility's contracted company that handles the supply and installation of the receptacle's that administer and hold these cleaning supplies. These are observed as in place as functioning and color coded. Eye washing stations are observed as well in the kitchen. Continued on next page... Page 2 Medications are observed to be locked in the medication room and medication carts. Carts are in place in the medication room. They can be moved around the facility. LPA audited medications of residents at random with staff and all are logged and tracked accurately using an electronic based tracking system. LPA observed that there are multiple fire extinguishers in place on each floor with an inspection date of 06/04/2025. Smoke detectors, carbon monoxide detectors, and full fire sprinkler system is observed in place through out the facility. Central heating and air conditioning is in place. Laundry room is also observed as fully operational and organized. Lint area behind dryers are observed as clean with no lint or extreme dust accumulation. Janitor cart is observed on second floor and are stored in janitor closet when not in use. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Evacuation chairs are in place in emergency exit stairwells as well. Last emergency/disaster drill was conducted in 07/24/2025. Water temperature was measured in resident rooms 165, 134, 271, and 207. Water temperature was measured to fluctuate between 108F and 112F. Of those 4 resident room, LPA observed to be free of odors and contained all the required furniture per regulatory recommendations. Resident rooms have walk in showers with non-skid flooring. Rooms have a pull cord call system in resident bathroom and by the bed in the resident room. Rooms have a kitchenette, but no cooking surfaces. Resident linen supplies are in place. Facility conducted last fire/disaster drill on 10/25/2025. LPA reviewed five staff files and five resident files during today's inspection. All files are observed as current. Staff are actively conducting training and it is observed as current for the staff reviewed. The following updated forms are requested to be submitted to CCLD by 11/25/2025 : • Copy administrator certificate • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule No citations issued. Report is reviewed with Mehrad Moshiri and a copy is provided on this day. Technical violations are given on the attached LIC9102TV pages.