Routine inspection·December 22, 2025

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Nilda Alpon. During the visit, LPA observed 6 residents and 2 staff. LPA explained the purpose of the visit. Kingman Care Home LLC is a level 4F home. LPA toured the facility inside out with Staff S1 which included the Living room, kitchen, dining room, 4 restrooms and 4 residents bedrooms. There was no obstruction to block the walkways. The staff area of the facility was also inspected. The front yard and backyard were inspected. LPA toured the facility garage, which was being used as a storage area. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F and hot water temperature was measured at 109 degrees F in resident bathrooms. Fire extinguisher was serviced in January 6, 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on November 15, 2025. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed 3 resident P&I records. Page 1 Out of 2. During visit, LPA Monter provided ADM with PIN 25-05-ASC Updated Medical Assessment for Residential Care Facilities for the Elderly (LIC 602A) Form. LPA requested the following documents for the change of administrator be sent to CCL by December 30, 2025. 1. Board of resolutions letter, stating the Date the new employee will begin working as Administrator and signed by the licensee, who is part of the corporation. 2. Administrators Certificate 3. LIC 501 4. Resume 5. LIC 500 6. LIC308. 7. LIC9182 8. Valid Photo ID No deficiencies cited during today's visit. This report was reviewed with Administrator Nilda Alpon and a copy of the signed report was provided. Page 2 Out of 2. END OF REPORT.