Correction check·December 5, 2025

Licensing Program Analyst Steve Chang conducted a POC case management visit to clear deficiencies cited on 09/11/2025, during the case management visit. LPA met with Administrator (ADM) Divina Fernandez. LPA explained the purpose of the visit to ADM. The Facility was cited the following Type B deficiencies on 09/11/2025. -87465(h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. LPA toured the facility with ADM including living room, dining room, main kitchen, dining area kitchen, 6 resident rooms, 3 bathrooms and staff break room. No medications was observed scattered unattested. Medication room was observed locked. In service staff training log with staff signature were provided by ADM. -87207 No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. ADM discussed with LPA. ADM stated he/she stayed at the facility from 8:00AM to 11:00AM Monday to Friday and he/she and weekend as needed. ADM stated he/she will spend more time at the facility if needed. ADM stated he/she will provided the time sheet for staying at the facility. Continue on LIC809-C. Page 1 of 2. -87463(e)The licensee shall immediately, or as soon as reasonably possible, bring any significant change in condition, as defined in Section 87101, Definitions, to the attention of the appropriate licensed medical professional and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident's record and shall include: ADM stated he/she keeps reminding staff to closely monitoring residents. For any change in condition, report to ADM or facility nurse immediately. ADM stated he/she keeps reminding caregiver to document the progress note. -87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)...(1) Knowledge of the requirements for providing care and ADM stated he/she will attend more continue education on care and supervision, administrator duties, and regulations. LPA received the plan of correction from ADM prior today's visit. LPA reviewed the POC with ADM. No Deficiencies was cited during todays visit. This report was reviewed by ADM . A copy of this report was provided to ADM. Page 2 of 2.