Routine inspection·September 5, 2025

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Irish Ladwig, Administrator. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area. LPA observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the first aid kit and found it to be complete. LPA toured two out of two resident bathrooms. LPA observed each bathroom to have available soap and paper towels and working lights. The water temperatures in the bathrooms measured at 106 F and 113 F. LPA toured six out of six resident bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA tested the smoke detectors in each hallway and resident bedrooms. Each smoke detector functioned properly when tested. LPA tested one out of one carbon monoxide detector, which functioned properly when tested. LPA toured the outside area and observed the outdoor exit to be clear of obstructions. LPA reviewed six out of six resident records, including Centrally Stored Medication and Destruction Records (CSMDR) and found them to be complete. See LIC809-C page for more information. Page 1 of 2. The emergency disaster drill log indicates the last drill was conducted on 08/05/2025. LPA reviewed four staff records and found them to be complete. During visit, LPA Marrufo obtained a copy of the following documents: LIC500 Personnel Report Current copy of the General Liability Insurance Certificate LPA Marrufo requests that the licensee submit the following updated form to Community Care Licensing by 09/12/2025: LIC610 Emergency Disaster Plan This report was reviewed with Irish Ladwig, Administrator, and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORT