Routine inspection·March 24, 2026

On 03/24/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required annual 1 year inspection visit. LPA met with the Administrator Ying Wang and explained the purpose of today's visit. During today's visit there are 5 residents present and 1 is in the hospital due to medical condition. There are 2 staff present including the administrator. This is a single level facility. This facility is licensed for 6 residents, 60 and over, whom all may be non-ambulatory. Hospice waiver on file for 2 residents. During today's visit there is 1 resident on hospice. LPA inspected the kitchen and found it clean, with breakfast preparation and cooking in progress at the time. Lunch was also being prepared for cooking. The appliances were checked and observed to be in working order. LPA inspected a locked drawer that contained knives and sharp objects are stored. Below the kitchen sink cleaning supplies are observed to be locked and not accessible to residents. Resident medications are locked as well in an upper cabinet in the kitchen. The refrigerator and pantry cabinets are inspected as sufficient in supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted in the refrigerator. The living room area is observed as clean, with all furniture in good repair. There is a sofa set, television, fireplace, and piano in the living room. LPA observed a fire extinguisher mounted on the wall in the living room with a purchase date of 01/24/2026. Facility has a hard wired combination smoke and carbon monoxide detectors as well as fire sprinklers through out. There is a fire pull station observed in the living room as well. Continued on LIC809-C Page 2 There are 6 bedrooms for residents, and one staff room. There are 2 common full bathrooms for resident use. All 6 resident rooms are single occupancy and are found to be clean, well-lit, and equipped with the required furniture outlined in Title 22. In the hallway connecting to to all resident rooms, there are closets designated for resident supplies such as incontinence care, linens, and incidental supplies. LPA inspected bathrooms and found them clean, sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip flooring. Water temperature is tested in two resident restrooms at 118F. The garage contains the washer, dryer, a refrigerator, a freezer containing additional food supplies. Cleaning supplies are observed as well located in the garage which is locked. A walk around of the outside perimeter and the backyard is conducted, and is observed as safe with fencing in place, no hazardous items or materials, and emergency exit routes are free and clear of any obstructions. There are two storage sheds observed as locked and housing gardening supplies and other items. LPA reviewed resident and staff records and found both to be current and complete. Staff training is in place and first aid cards are present. Last fire drill conducted was on 01/07/2026 per records observed, which was a fire drill that took place. LPA inspected the first aid kit and found it fully stocked as well during today's visit. Medications and its records are observed to be current and logged accurately. LIC500 Personnel Report LIC308 Designation of Facility Responsibility Certificate of Liability Insurance Copy of Administrator Certificate. No citations issued on this day. Technical Assistance is provided and can be foundon the the attached LIC9102TA. Report is reviewed with administrator Ying Wag and a copy is provided.