Autumn Hills Residential Home

Allegation investigated: Staff did not prevent exit doors form being blocked Staff do not keep the facility maintained

Licensing Program Analyst (LPA) Evelin Rios and Licensing Program Manager (LPM) Mary Flores conducted an unannounced complaint visit at this facility for the above allegations. LPA was greeted and granted access by a staff member. The administrator, Augustine Kehinde met LPA and LPM shortly after. LPA explained the reason for the visit. An entrance interview was conducted. The investigation consisted of the following: LPA initiated a physical plant tour of the facility to ensure the health and safety of residents in care. While conducting the tour, from 9:10 a.m., to 10:40 a.m., LPA interviewed four (4) out of four (4) residents and two (2) staff. At approximately, 11:45 a.m., LPA and LPM interviewed the administrator. LPA obtained and reviewed copies of the facility's resident roster, personnel report (LIC 500), residents' admission agreements, residents', physician's reports, and Resident Personal Property and Valuables document. The investigation revealed the following: Regarding allegation: Staff did not prevent exit doors from being blocked. It is alleged that an exit door is blocked with objects. (Continue to LIC9099-C) Substantiated Interviews with residents revealed exit doors have not been blocked preventing residents from using the doors. Interviews with staff revealed staff do not block the exit doors at the facility to prevent residents from exiting. They have a sound device monitoring system that notifies them when an exit door is open. During the facility’s tour, LPA observed room #2(BR#2), which is a share room with two hospital beds, a curtain in the middle to provide privacy, a stack of storage space to the right of the bed closest to the exit. An exit door to the left of the bed and a tray table blocking the passageway to the exit door. There is about 3 feet of space between the beds and about 2 1/2 feet in between the bed closest to the exit doors and the wall passageway. And about 2 feet between the end of the beds and the wall where the closet is located. Even though the tray table can be moved it causes a hazard in case of an emergency by blocking the exit door. Therefore, this allegation is substantiated. Based on LPA's observations, interviews which were conducted, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Regarding allegation Staff do not keep the facility maintained. It is alleged there are hazards in the facility’s backyard due to lack of maintenance. Interviews with residents revealed the facility is in working condition. Interviews with staff revealed the administrator is in charge of any repairs at the home and does a review of the home at least twice a week. During the tour of the facility LPA observed, carpet ripped with a gap of about an inch from wall to wall in room #4(BR#4)’s doorway. Room #1(BR#1) had a dent in the wall where the bed is against it, and it is eye level to the resident in care, a screw was observed in the corner of the room. Bathroom #1(BT#1) has a crack with an opening in the wall under the towel rack the size an orange. The backyard has a cover pergola over the exit door from the family room into the backyard that was observed cracking probably from water damage, the ground floor has a crack the size of a grapefruit on the right side of the patio area, screen door was observed leaning against the wall over a bicycle, a landscape border was observed bended and down against the dirt in the garden area, a broken rake was observed laying in the grass area. Based on LPAs observations, interviews which were conducted, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview was conducted and a copy of this report, LIC9099D, and appeal rights was provided to administrator. The investigation revealed the following: Regarding the allegation: Staff yell at residents. It is alleged that staff scream and curse at the residents. LPA’s interviews with two (2) staff members stated they have not yelled at residents nor witnessed any staff yelling or curse at residents. One (1) staff member stated that they have a loud voice but are not yelling at residents. Interview with the administrator denied the allegation, stating staff have training regarding personal rights and know not to do that. LPA’s interviews with four (4) out of (4) residents denied the allegation, stating staff have not yelled or cursed at them and they have not witness staff yelling at other residents. One (1) resident stated that they do not like the attitude of one (1) staff member but did not wish to elaborate. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the Allegation: Staff are not meeting residents laundry needs. It is alleged that bed sheets and laundry haven’t been done for weeks. LPA’s interviews with two (2) staff members stated they schedule laundry service twice a week and as needed. One (1) staff member stated that they will wash bedding and resident’s clothes right away if someone has had an accident and that there is a resident that may refuse their bed sheets changed. LPA’s interviews with four (4) out of (4) residents reported that staff take care of laundry service and have no concerns regarding laundry. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation: Staff are not meeting residents bedding needs. It is alleged, that residents have stains on their sheets that have been there for three weeks. LPA’s interviews with two (2) staff members stated they change bedding once a week or as needed. One (1) staff member stated that one (1) resident may refuse their bedding changed and another resident requires frequent bedding changes. LPA’s interviews with four (4) out of (4) residents reported that staff change their bedding. One (1) resident stated that they prefer to make their own bed and that their bed sheets were changed two days ago. Another resident reported their bed sheets were changed yesterday. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. (Continue to LIC9099-C) Page 2 of 4 Regarding the Allegation: Staff are not providing adequate food service to residents. It is alleged, that residents are only served hotdogs, rice and noodles. LPA’s interviews with two (2) staff members stated they follow a menu and residents have not complained about meals. One (1) staff member stated that they do serve hotdogs but will serve various balanced meals as well. LPA’s interviews with four (4) out of (4) residents denied the allegation, stating staff provide different meals consisting of protein, grains and vegetables. Interview with one (1) resident stated they request soft or liquified food and staff will follow their instructions. LPA’s review of residents’ Physician’s Reports did not indicate any residents have a prescribed special diet. LPA observed various food in the refrigerator and pantry. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the Allegation: Staff did not prevent a resident from entering another resident's room. It is alleged, that a resident goes into other residents rooms. LPA’s interviews with one (1) of (2) staff members stated there are two residents that enter another residents room. One of those residents was a previous roommate and will go into the room with permission. The other resident had entered the room after the resident residing in the room had offered them snacks and may enter again but is redirected. Interview with the administrator revealed, one (1) resident when they were first admitted to the facility was wandering at night and had entered another residents room but may have been sleepwalking or had entered the room by mistake. The resident was re-evaluated and with new physician orders has improved wandering behavior. LPA’s interviews with four (4) out of (4) residents reported no issues with residents entering their rooms. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. (Continue to LIC9099-C) Page 3 of 4 Regarding allegation: Staff did not safeguard resident’s personal belongings. It is alleged a watch was stolen from a resident. Interviews conducted with residents revealed that none of their personal belongings have gone missing. Interviews conducted with staff revealed one resident had claimed to have lost their wallet. However, staff looked for the wallet and was found and no other residents reported anything missing. LPA reviewed Resident Personal and Property Values sheets for four (4) residents, each list their personal belongings such as clothing, glasses, and other items. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding allegation: Staff do not provide activities for the residents. It is alleged there are no activities available for the residents and residents only watch TV. Interviews with residents revealed residents prefer to watch TV. Two (2) residents stated that there are volunteers who come to either play chess or provide entertainment. Residents also stated that they like taking walks. Interviews with staff revealed residents would rather watch TV than engage in activities. During facility’s tour LPA observed a set of domino and a board game that was stored in the closet and some magazines in the living room. Facility maintains a daily activity sheet that includes activities of daily living(ADLs), brisk walk, leg pedaling, tea time, free activities, drawing, games, reading, and karaoke. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding allegation: Staff are inappropriately punishing residents. It is alleged a resident is being asked to stay in their room as a result for using the bathroom consistently. Interviews with residents revealed staff treat them with respect and have not been threatened or punished by the staff. Interviews with staff revealed that staff treat the residents with respect, they are aware not to threaten or punish the residents. Personal Rights training was provided on 4/21/2026 to the staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted. Copy of report provided to administrator. Page 4 of 4the state’s words, verbatim · CDSS document, Jul 7, 2026 · control 31-AS-20260702115847

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a)(2)(A) · Plan of correction due date: Jul 8, 2026

Personal Accommodations and Services (a)... provide comfortable living accommodations... The following provisions shall apply: (2) Resident bedrooms shall... : (A)... allow for easy passage... This requirement is not met as evidenced by: Based on observations the licensee did not ensure a exit door was not blocked by a tray table and furniture did not allow for easy passage around bedroom #2 which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 7, 2026

Plan of correction: The administrator will certify in writing a plan of how the room will be re arranged with the required furniture to ensure passageways and exit doors are not blocked and send the statement to the department by POC due date 07/08/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 17, 2026

Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observations the licensee did not ensure facility was free of wall holes/cracks, floor cracks and carpet damage and maintain the black yard organized which poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 7, 2026

Plan of correction: The administrator will repair issues to facility and send a picture of the repairs to the department by POC due date 07/17/2026.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Evelin Rios conducted an Annual Required visit and inspection of the facility. This is a Residential Care Facility for the Elderly (RCFE) approved for five non ambulatory residents and 1 bedridden resident in bedroom #3. LPA rang the door bell and was greeted and granted access by a staff member who contacted the Administrator, Augustine Kehinde. LPA met the administrator shortly after and explained the reason for the visit. A physical plant tour was conducted of the facility inside and out and the LPA observed the following: At entry LPA observed required postings on the wall near the front door and the hallway leading to resident bedrooms. By the entry there is a closet where the facility stores extra hygiene products for the residents. Bedrooms: There are four (04) resident bedrooms in total. Two (02) bedrooms are shared and two (02) bedrooms are for private use. Resident bedrooms were observed properly furnished with appropriate beds, night stands and chairs. Doors in bedrooms leading to the outside have auditory alarms that were observed functional. Bathrooms: There two (2) and one-half (1/2) bathrooms. Two (2) are designated for resident use. Bathrooms were properly supplied and had functional fixtures. LPA took the hot water temperature from two (02) out of three (02) bathrooms and they measured between 107.6 and 111.2 degrees Fahrenheit. Kitchen: The kitchen appliances and fixtures were functional. LPA also observed a 7 day non-perishable and a 2 day perishable supply of food in the facility. The fire extinguishers are located by the entry and in the kitchen. They were observed fully charged with service date 04/13/26. Common Areas: These included two (02) living rooms, and the dining area. The common areas were properly furnished. The dining room has a table with chairs to sit the capacity of the facility. The living rooms have televisions and couches. The facility has a telephone accessible to residents. Surrounding Grounds: The backyard is fenced in. LPA observed that the entry/exits were free of obstruction. There is a shaded area for residents to use. The backyard is sufficient in space for outdoor exercise and activities. No bodies of water observed. Laundry/Garage: The laundry area is located in the attached garage. The door leading to the garage was observed locked. Cleaning supplies and detergents are kept locked in the garage. From 12:52 p.m. to 1:30 p.m., LPA reviewed four (4) of four (4) resident records and (4) staff records. Records were complete and in compliance with licensing forms. Medications are centrally stored and were observed locked in a cabinet by the workstation. Medications and medication records were reviewed for proper documentation. Centrally Stored Medication Records are manually completed by staff and facility keeps a Medication Administration Record (MAR). LPA reviewed the facility's, Certificate of Liability Insurance, Personnel Report (LIC500), Emergency Disaster Plan (LIC610E), and last Fire Drill training conducted on 04/01/2026. LPA requested that a copy of LIC610E and liability insurance be emailed to update the Regional Office facility file. The posted facility sketch and bedroom designations are inconsistent with Fire Safety Inspection (STD 850) dated 03/09/2007 however, Regional Office facility file has an STD 850 dated 03/05/2008 missing a facility sketch. LPA requested the administrator submit the facility sketch they are currently using and will follow up with the Fire Prevention Division regarding bedroom designations. Smoke detectors/carbon monoxide. All resident rooms are equipped with smoke detectors and the facility's smoke detectors are hard wired and interconnected. The facility has two (2) carbon monoxide detector is located in the hallway leading to the bedrooms and another one in the living room. Detectors were tested by administrator at 2:00 p.m., and were observed operational. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during todays visit. Exit interview conducted. A copy of this report provided to the administrator.the state’s words, verbatim · CDSS document, May 12, 2026

Allegation investigated: Staff does not provide resident with assistance. Staff do not treat resident(s) with dignity and respect.

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit at this facility for the above allegations. LPA was greeted and granted access by Staff#1 (S1). The administrator, Augustine Kehinde could not meet LPA. LPA met with the administrator designee, Adebisi Ogunsaju shortly after. LPA explained the reason for the visit. To investigate the allegations LPA initiated a physical plant tour of the facility to ensure the health and safety of residents in care. LPA did not observe any health or safety concerns. While conducting the tour, from 9:33 a.m., to 10:30 a.m., LPA interviewed four (4) out of four (4) residents and two (2) staff. At approximately 10:30 a.m., LPA obtained and reviewed copies of the facility's roster, personnel report (LIC500), resdients' admission agreements, resdients' physician's reports, and residents' appraisals. (Continue to LIC9099-C) Unsubstantiated (Continued from LIC9099) Allegation: Staff does not provide resident with assistance. In regards to the allegation, it was reported that staff are not assisting Resident #1 (R1) with Activities of Daily Living (ADLs) such as bathing, cleaning or ambulating. LPA's interview with one (1) out of the four (4) residents stated that staff initially helped them with bathing and transferring out of bed. However, the resident later refused further assistance due to Staff #1’s (S1) rude behavior and lack of effort. The resident reported that S1 made dismissive remarks, such as stating they "don’t have time to assist". Interview with three (3) out of four (4) residents reported they receive varying degrees of assistance with ADLs from staff based on their own ability and denied having issues receiving such assistance when they need it or ask for it. Although one (1) of these residents denied the allegation they stated S1 had been rude when they had asked for an item. Four (4) out of four (4) residents deny witnessing staff refuse to provide assistance to other residents. LPA's interview with staff denied the allegation, reporting that assistance is offered regularly, but some residents decline help, telling staff, they are capable of doing things independently. LPA's review of R1's physician's report revealed R1's physician checked that R1 has the capacity for self-care. Although the allegation may have happened or is valid, there is not enough evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time Allegation: Staff do not treat resident(s) with dignity and respect. In regards to the allegation it was reported, that Resident #1 (R1) was told to go back to their room because they were being too noisy. During interviews with staff, staff denied the allegation. According to Staff #1 (S1), they have a routine cleaning schedule and had asked R1 to return to their room only until they had finished cleaning. Interview with staff deny telling any resident they are being too noisy. LPA's interview with two (02) out of four (04) residents reported they feel staff do not treat them with dignity and respect. All other residents stated they feel staff treat them with respect and dignity. LPAs interview with four (4) out of four (4) residents deny witnessing staff being disrespectful to other residents. Based on interviews, and conflicting information there is not enough evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 20, 2025 · control 31-AS-20251118152752

Type of visit: Required - 1 Year

On 05/29/2025 Licensing Program Analyst (LPA) Evelin Rios conducted an Annual Required visit and inspection of the facility. The inspection tool was used for todays visit. LPA met with Staff#1 (S1) who granted access and contacted the Administrator, Augustine Kehinde. LPA met the administrator shortly after and explained the reason for the visit. Physical tour was conducted and LPA observed the following: At entry LPA observed appropriate postings on the wall near the front door and the hallway leading to residents bedrooms and bathroom. Kitchen: At 11:32 AM, LPA observed S1 washing dishes. The kitchen appliances and fixtures were functional. LPA also observed enough 7 day non-perishable amount of food and a 2 day perishable supply of food in the facility. Staff #2 (S2) arrived to the facility at 11:39 a.m., with more groceries. Bedrooms: There are four (04) resident bedrooms in total. Two (02) bedrooms are shared and two (02) bedrooms are for private use. Resident bedrooms were observed clean and clear of clutter, properly furnished with appropriate beds, night stands and chairs. Doors in bedrooms leading to the outside had auditory alarms that were observed functional. In the hallway closet leading to bedrooms labeled 2 and 3 LPA observed extra bed and bath linens. Bathrooms: There are three (03) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. From 12:27 p.m. to 12:30 p.m. LPA took the hot water temperature from two (02) out of three (03) bathroom and they measured between 110.1 and 119.1 degrees Fahrenheit, within regulation. (Continue on LIC809-C) Common Areas: These included two (02) living rooms, and the dining area. The common areas were properly furnished. The dining room has a table with chairs to sit the capacity of the facility. The living rooms have televisions and couches that were observed in good repair. Outside/Surrounding Grounds: LPA observed that the entry/exits were free of obstruction. There is a shaded area for residents to use and furniture appropriate for outdoor use. The backyard is sufficient in space for outdoor exercise and activities. No bodies of water observed. Laundry/Garage: The laundry area is located in the attached garage. there is access to the garage inside the facility. The door leading to the garage was observed locked. Cleaning supplies and detergents are kept locked in the garage. The garage is used for facility storage. STAFF WORKSTATION: Facility has a work station for staff. The work station is located by the dining area. Facility files and resident records are stored in a locked cabinet in the workstation. Medications are stored in a locked cabinet in the work station. A first aid kit is kept in the locked cabinet with the medications. Smoke detectors/carbon monoxide. All resident rooms are equipped with smoke detectors and the facility's smoke detectors are hard wired and interconnected. There is a pull station located at the front entrance. The carbon monoxide detector is located in the hallway. Detectors were tested by administrator at 1:17 p.m., and were observed operational. The fire extinguishers are located by the entry and in the kitchen. They were observed fully charged with service date 04/21/25. From 1:20 p.m. to 2:30 p.m., LPA reviewed six (06) of six (06) resident records and (3) staff records. Records were observed locked in a workstation cabinet, complete and up-to-date. At 2:31 p.m., LPA reviewed residents' centrally stored medication and medication records. LPA observed medications are centrally stored and locked in the work station cabinet. LPA collected a copy of the Certificate of Liability Insurance, and LIC500. LPA reviewed administrator certificate, LIC610E, and last Fire Drill training conducted on 02/22/2025. No deficiency cited during today’s visit. Exit interview conducted and copy of this report signed and providedthe state’s words, verbatim · CDSS document, May 29, 2025

Allegation investigated: Staff blocked exit to resident's room.

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit at this facility for the above allegation. LPA was greeted and granted accesses by staff#1 (S1). S2 contacted the administrator via telephone and LPA explained the reason for the visit. The administrator, Augustine Kehinde informed LPA they would meet LPA at the facility. Allegation: Staff blocked exit to resident's room. In regards to the allegation, it was reported a wooden board was being used to block the only exit to resident #1's (R1's) bedroom. To investigate the allegation LPA toured the facility to ensure the health and safety of resident's. LPA did not observe a wooden plank or board anywhere in the facility. From approximately 12:23 p.m. to 1:00 p.m. LPA interviewed four (4) residents, the administrator, S1 and S2. LPA did not obtain information about the allegation from R1's interview. At approximately 1:25 p.m. LPA obtained copies of R1's physician report, unusual incident report and mental health appointments. (Continued to LIC9099-C) Substantiated (Continued from LIC9099) At 2:23 p.m. LPA interview two (2) more residents. LPA's review of R1's physician report revealed the physician did not select yes or no for "able to leave the facility unassisted" question. According to the administrator the primary care physician was leaving the response up to R1 psychiatrist. According to the administrator the psychiatrist had verbally told them R1 cannot leave the facility unassisted. LPA's interview with administrator and S1 revealed R1 has gotten lost in the past and tends to pick up trash from the floor to eat. LPA's interview with S2 confirmed there was a piece of wood holding R1's door closed because R1 is prone to leaving the facility unassisted. LPA's interview with the Administrator confirms he found out about the wood and immediately instructed his staff to throw it away. According to the administrator R1 has had an escalation of behaviors due to R1's mental health diagnosis. Administrator states his staff informed him R1 has made threats to staff and residents prompting staff to keep R1 in their room afraid R1 may attack another resident. Interview with four (4) out of six (6) residents that responding to LPA's questioning state they feel safe with staff at the facility and are able to leave the facility when they want. Administrator states in-service training has been conducted regarding residents personal rights. Administrator provided copies of in-service sign in sheet to LPA. Based on LPA's interviews the allegation is deemed Substantiated at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D). Exit interview conducted. Appeal rights provided and a copy of this report issued.the state’s words, verbatim · CDSS document, Oct 29, 2024 · control 31-AS-20241022152637

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Oct 30, 2024

(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(6) To leave or depart the facility at any time and to not be locked into any room, building or on facility premises by day or night. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the regulation cited as staff would obstruct R1's bedroom door preventing R1 from exiting which posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 29, 2024

Plan of correction: The administrator has thrown away the wood used to obstruct bedroom door and has had inservice training with his staff relating to personal accommodations and services. POC cleared today.

Type of visit: Required - 1 Year

On 04/29/2024 at 9:30 a.m. Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility listed above to conduct an unannounced annual inspection. LPA was greeted by staff #1 (S1) and granted access. S1 called the Administrator Agustine Kehinde and the reason for the visit was explained. Administrator would not be able to attend at the moment but would be arriving at a later time. Administrator designated House Manager (HA) Adebisi Ogunsajo to assist LPA in the meantime. At 10:00 a.m. LPA and the HA toured the physical plant of the facility inside and outside, and the following was observed. Living room: There are 2 living room areas, both were clean and properly furnished. LPA observed one (1) fire extinguisher fully charged last serviced 04/26/2024. Kitchen: The kitchen was observed to be clean and clear of clutter. Appliances and fixtures were functioning properly. LPA observed cleaning products kept locked under the kitchen sink. LPA observed knives locked in a bottom cabinet. LPA observed a sufficient amount of 2- day perishable and 7-day non-perishable food at the facility all properly stored. LPA observed a second fridge in the kitchen meant for staff only. LPA observed a second fire extinguisher fully charged with a last serviced date of 04/26/2024. Dining area had an appropriate table, and chairs to sit the capacity of the facility. Bedrooms: LPA inspected five (5) out of five (5) bedrooms. Four (4) out of Five (5) bedrooms are for resident use. Two (2) bedrooms are currently shared by two (2) residents. LPA observed each resident room to be properly furnished with a bed, bedding, night-stand, chair, and with sufficient lighting and storage. LPA observed extra linens in a hallway cabinet outside the bedrooms. One (1) bedroom is used for live in staff, it was locked and inaccessible to residents. (Continued on LIC809-C) Bathrooms: The facility has 3 bathrooms. LPA took water temperature at 10:15 a.m. from one (1) out of the three (3) bathroom's sink and temperature read 105.0 degrees F. LPA observed the bathrooms to be clean and properly supplied with toilet paper, soap, paper towels. Laundry/Garage: Laundry area is located in the garage. Garage is inaccessible to clients. Detergents are kept locked in the garage. Surrounding Grounds: Entry and exits were free from obstructions. There is covered patio. LPA observed appropriate furniture for residents to use. There is a small shed that was locked and used to store extra facility supplies. Administrative: LPA collected Resident Roster, LIC500 and Liability Insurance. Annual fees are current. Resident Records: From 10:30 a.m. to 11:30. a.m. LPA reviewed resident records. Staff Records: From 11:30 a.m to 12:00 p.m. LPA reviewed staff records. Interviews: From 12:30 p.m. to 2:00 p.m. LPA conducted interviews with four (4) out of four (4) residents and three (3) out of four (4) staff present. At 1:00 p.m. LPA observed Administrator test a dual smoke and carbon monoxide detector. Detectors are hardwired and interconnected to other detectors located throughout the facility. Detectors were observed to be functioning properly. Medication: Medication Records were reviewed for proper documentation. Centrally stored medications are maintained in a locked cabinet by the kitchen and dining area. Medications were observed locked. No citations issued. Exit Interview Conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Apr 29, 2024