Correction check·October 9, 2025

On October 9, 2025, LPA Manuel Monter and Marcella Tarin conducted a POC visit. LPAs met with Administrator / Licensee Xi-Hua Luo (ADM1). LPAs explained the purpose of the visit. On October 2, 2025, the facility was issued the following Type A Deficiencies with a POC date of October 3, 2025. As of today’s visit, the licensee has not submitted or corrected citations resulting in civil penalties. The following deficiencies were cited during a complaint investigation visit/ case management deficiencies visit conducted on October 2, 2025, and are as follows: • 87468.1 Personal Rights of Residents in All Facilities (a) - Type A, issued initial Civil Penalty (CP) of $500.00 beginning October 4, 2025, and will continue to accrue until corrected. • 87202 Fire Clearance (a) -Type A, Issued initial CP of $500.00 beginning October 4, 2025, and will continue to accrue until corrected. • 87755 Inspection Authority of the Licensing Agency (a) - Type A, Issued initial CP of $500.00 beginning October 4, 2025 and will continue to accrue until corrected. Civil Penalties issued today for the maximum of $1500, for failure to correct. LPAs informed ADM that if the 3 deficiencies are not corrected, civil penalty will continue to accrue until corrected. LPA discussed about the importance of Plan of Correction. ADM agreed and understood. Page 1 Out of 2. The Facility was cited an additional deficiency during todays visit, under code section, 87405 Administrator Qualifications and Duties (d)(2). During today's inspection deficiencies were issued. See LIC809D. This report was reviewed with Administrator / Licensee Xi-Hua Luo (ADM1). A copy of this report was provided during exit interview. Appeal rights were provided. Page 2 Out of 2.