Non-compliance follow-up·July 3, 2025

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management for a Non-Compliance Plan Quarterly Visit and met with Donna Lagman. LPA observed 2 staff and 2 residents were observed in the facility. The purpose of the visit is to ensure the facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) after an Noncompliance Conference meeting held on 9/19/2024. LPA toured the facility with staff S1 including resident rooms and backyard. LPA reviewed the LIC 500 with backup Administrator (S2). LPA observed 1 on-call staff and 1 awake staff on NOC shift which includes the hours of 9pm to 9am daily. LPA reviewed the LIC 500 to observe backup Administrator at the facility. LPA reviewed the caregiver daily log for the April, May, June, and July 2025. Back-up Administrator S2 stated the caregiver daily log was reviewed every Wednesday. LPA reviewed resident progress notes for April, May, June and July 2025. Backup Administrator S2 stated resident progress notes were reviewed and updated every Wednesday. LPA reviewed residents' physician reports, and appraisal needs and service plans with backup Administrator S2. LPA reviewed residents' medications and centrally stored medication forms with ADM. ADM stated he/she reviews all resident's medications on a weekly basis and back-up Administrator S2 reviews the centrally stored medication forms and medication administrator record for accuracy and update. Continue on LIC809-C. Page 1 of 2. The case management of inspections will be conducted every 3 months for 2 years. No citation noted today. Exit interview was conducted with ADM. The report was provided to ADM for review and signature. A copy of the report was provided to ADM. Page 2 of 2.