Routine inspection·December 3, 2025

At 12:30 p.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. At approximately 12:50 p.m. Licensee Bonnie Haave arrived and was informed of the reason for the visit. At 01:00 p.m. the LPA conducted a tour of the physical plant with the Licensee to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of six (6) resident bedrooms, one (1) live-in staff room, and two (2) restrooms. The LPA observed one (1) fire extinguishers which was fully charged and last serviced 03/17/2025. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the kitchen. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Kitchen : During the facility tour. the kitchen appeared clean and the appliances and fixtures functional. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Sharps are stored in a locked drawer. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: The LPA observed all bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. Water temperature in resident’s restroom was measured at 105 degrees Fahrenheit. Report will continue on LIC809-C. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. The facility maintained a comfortable temperature of 74 degrees. There were no obstructions and/or tripping hazards throughout the facility. Cleaning supplies and disinfectants are kept in a locked closet in the hallway between the kitchen and bedrooms along with the washer and dryer. Surrounding Grounds (Outdoors) : The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. I nterviews: The LPA conducted one (1) resident interview. No concerns were voiced. Record Review: At 01:15 p.m. a review of facility files was initiated. The LPA reviewed five (5) out of six (6) resident files. The following was observed: Resident 1 did not have a Consent for Emergency Medical Treatment on file or their Admission Agreement on file. Upon observation the Licensee stated that they believe R1's family member has the admission agreement and would request it. Resident 2-5 did not have an updated Appraisal/Needs and Services Plan (LIC625) on file, all their LIC 625 were from 2023. At approximately 3:15 p.m. the Licensee had to leave and designated staff Maria Dye to review and sign the report. Due to time constraints the LPA will return at a later date to complete the annual. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided,