Routine inspection·January 8, 2026

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff S1 Abijuan Burchell. During the visit, LPA observed 3 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 2 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 resident bedroom #5. LPA observed on the cabinet next to R1's bed contained a medication. LPA reviewed R1's Physician's Report dated April 22, 2021, states R1 cannot administer and/or store his/her own medications. While touring bedroom #4, LPA observed frame missing from the door. LPA toured bedroom #2, and observed a hole, in the wall. This whole matches the path of the door for bedroom #2 opening. LPA also observed damage to the door frame in bathroom #2. LPA also observed the sliding door screen for bedroom #5 was not attached. LPA toured the backyard of the facility. LPA observed leaves and multiple fruits in the ground, directly across from bedrooms 2 & 3, and the patio. Page 1 Out of 3 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 119 degrees F in resident bathrooms. 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 October 10, 2025. LPA reviewed facility records for 3 staff and 3 residents. LPA noted that R1's Physician's report is dated April 22, 2021. LPA requested to review documentation demonstrating the Administrator requested an updated physician's report from the resident and/or the residents representative. The Administrator also did not provide any documentation showing that R1 or R1's representative had reused to receive annual assessment for an updated physician's report. LPA requested to review Staff S2's LIC501, LIC503 and documentation of training. LPA was not provided the following but not limited to documents regarding S2 to review/inspect : LIC501, Staff training records, LIC503. LPA reviewed 3 resident medications and centrally stored medication records. Resident R1 and R2's Centrally stored medication Record forms only has medications with start dates from the year 2024. LPA asked S1 for the most current forms for R1 and R2. S1 stated they only fill out the centrally stored medication records once a year. LPA informed S1 that the centrally stored medication record must be updated continuously. The record must be updated every time a new medication has been prescribed by the residents doctor. Page 2 Out of 3. The Department is issuing an immediate civil penalty of $250 for each repeat violation for the following deficiencies: 87463 Reappraisals (h), which was previously cited on January 16, 2025 Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. This report was reviewed with Staff Abijuan Burchell and a copy of the report was provided. Appeal Rights was provided. Page 3 Out of 3. End of Report