Routine inspection·September 17, 2025

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required 1 year annual inspection. LPA met with Administrator, Lisa Lanford. The facility is currently undergoing a change of ownership and the new owner has submitted an application to the Department which is currently pending. All residents, family and staff were made aware of the upcoming change. During visit, LPA toured the facility with ADM to include all resident bedrooms, bathrooms, shower room, staff lounge, dining room, living room, kitchen, and laundry room. Facility temperature maintained at 70 degrees F. Emergency exit doors observed with door alarms. 1 out of 3 of the door alarms which was next to bedroom #1 observed not operable. During visit, the maintenance personnel replaced the battery of the door alarm in which LPA observed the door alarm was operable. Fire extinguisher last serviced on 10/24/2024. Facility equipped with carbon monoxide detectors in the kitchen and hallways. All resident bedrooms equipped with beds, linens, night stands, dressers, lidded trash bins, and adequate lighting. Residents whose beds are equipped with half rails has a physician order on file for the use of half rails. Page 1 of 3. LPA measured the hot water temperature in bedroom #1. LPA observed the sink in bedroom #1 was not properly draining causing the sink to be clogged. The maintenance personnel fixed the sink drainage during visit. The hot water temperature was measured at 119 degrees F. The hot water temperature in bedroom #9 measured at 133.7 degrees F. Hot water temperature in bedroom #10 measured at 126.5 degrees F. During visit, the maintenance personnel attempted to lower the hot water temperature but then states the knob to adjust the water temperature is broken. The maintenance personnel states to have called a plumber in which the plumber is scheduled to come to the facility the morning of 09/18/2025. In the meantime, the ADM states a plan to measure the hot water temperature in all bathroom sinks and shower room and place caution signs next to the sinks whose hot water temperature exceeds more than 120 degrees F, while the facility is waiting to lower the hot water temperature. A Type A deficiency is being cited today per Title 22 Section 87303(e)(2) for the hot water temperature exceeding more than 120 degrees F in bedroom #9 and #10. LPA toured the kitchen area. LPA observed a perishable food supply of at least 2 days and a nonperishable food supply of 7 days. Toxins and chemicals are stored separately from the food supply. LPA observed the pilot light of the gas stove is left continuously on. ADM states the brand of the stove is designed to have the pilot light left of on continuously. LPA advised of safety concerns as there were plastic seasoning containers above the stove where the pilot light was on. ADM stated understanding. During visit, the maintenance personnel placed a carbon monoxide detector in the kitchen area. Refrigerator temperatures maintained at 36 degrees F. Freezer temperature maintained at 0 degrees F. LPA toured the resident dining area. LPA observed a wooden plank in the track of the sliding glass door obstructing the sliding glass door in the dining room. The sliding door leads out to front of facility. A Type A deficiency is being cited today per Title 22 Section 87307(d)(6) wherein the sliding door track in the dining room which leads to the front of the facility was obstructed by a wooden plank which did not allow the sliding door to open freely. Page 2 of 3. 5 residents records were reviewed. 5 out of 5 resident records observed complete and up-to-date. ADM states the needs and services plans are verbally reviewed with the resident and families however the new forms that were developed are not being signed. ADM states a plan to revise the needs and services plan to include a signature portion as acknowledgement that the plan was reviewed and agreed upon. 5 residents centrally stored medications and records were reviewed and no issues were noted. 3 staff files were reviewed and the staff files were complete to include a 1st aid certification, health screening, TB result, personnel record and staff training. Emergency drills are completed quarterly and the last drill was completed on 09/07/2025. Documents were requested to update the facility file to include by 09/24/2025: Lease agreement, LIC308, liability insurance, LIC500, administrator certificates, and surety bond (if applicable). Licensee was informed that the annual licensing fee has not been paid as of 09/17/2025. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with ADM Lisa Lanford and a copy of the report and appeal rights was provided. Page 3 of 3.