Madison Square Senior Living

Type of visit: Office

On 8/20/26, a virtual Teams meeting was held, at the licensee's request, to discuss the process for review and approval of age exception requests. The meeting was attended by Darius Stir, Administrator, Laura Munoz, Licensing Program Manager and Kevin Mknelly, Licensing Program Analyst. Currently, there are 5 residents in care, 2 of the residents are under 60 years old. Items discussed: Mr. Stir stated the goal of seeking clarification of terms and conditions for requesting approval; The CCLD regulations for exception requests, acceptance and retention of residents who are compatible and that the facilities plan of operations are in place to accept residents of various needs. In the meeting Mr. Stir was requested to update and submit addendums to the current plan of operations that addresses the needs of residents to be considered for admission, including but not limited to staff training for known conditions of residents, staffing needs based on resident needs and safety measures that can be posed by resident conditions. Mr. Stir was referred to facility reports of 5/14/26 and 6/4/26 for details of items to be addressed on the plan of operations and exception requests previously discussed. When the addendums are submitted, the department will review the plan and respond with approval or request for additional clarification. Further exception requests may be submitted and considered based on the residents needs as they relate to the plan of operations. As a result of this meeting, no deficiencies were cited. Report sent to licensee for signature.the state’s words, verbatim · CDSS document, Aug 20, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Kevin Mknelly arrived on 6/4/26 for the purpose of conducting Plan of Correction (POC) inspection for deficiencies issued on 5/14/26, with a correction date of 5/29/26. LPA was greeted by caregiver. On 5/14/26 deficiencies were cited for Acceptance and Retention violations. 4 of the 5 residents present on 5/14/26 were under sixty (60) years of age. The younger population admitted present with social, behavioral and clinical presentation that differ from the licensee’s plan of operations for the care of seniors and seniors with neuro-cognitive disorders. Administrator and staff have training pertaining to the care of seniors. Regulation applying to adults 18-59, at times differ from Senior Regs. An exception request was submitted by the Administrator on 5/29/26 was for R2 identified in the previous visit. Additional exception requests for R1 and R3 were under review by the department pending additional information requested in the Plan of Correction(POC). The conditions included: report continued... · Care and supervision of residents with neurologic illness, mental health diagnosis or severe cognitive impairment, including behavior management and safety awareness • Assistance with activities of daily living (ADLs), including care for non-ambulatory residents addressing cognitive and physical issues. • Medication management and administration, including monitoring for side effects and ensuring compliance • Emergency preparedness and evacuation procedures if other that currently on file that address current resident distinct needs. • Mental health training, including recognizing and responding to symptoms associated with conditions such as schizophrenia and traumatic brain injury In addition, we need the administrator to provide us with updated program plan for the following: In addition to staff training, you must provide documentation demonstrating the following- • A staffing plan that clearly outlines how staff will meet the increased supervision and care needs of all residents at all times • A written plan describing how compatibility among residents will be maintained, including supervision strategies and daily structure • A plan to ensure ongoing monitoring of residents’ changing needs and staff responsiveness. - Plan for ensuring the care and social needs of residents. As these conditions have not yet been met in full, this POC has not yet completed. Civil penalties are issued. Additionally, the exception requests submitted have not been approved. Failure to submit the requested additional information may result in residents without approved exceptions my need to move from the home. Additional deficiencies are not issued at this time. The report was reviewed, civil penalties issued and copy of report was providedthe state’s words, verbatim · CDSS document, Jun 4, 2026

Type of visit: Case Management - Other

On 5/14/26, LPA Mknelly conducted a case management visit and met with designee, Samantha Shaw. This is a follow-up visit for the visit conducted 4/28/26 where is was observed that 4 out of 5 residents are under the age of 60. Administrator submitted age exception requests for R1 and R4. The requests are under review pending further information requested in this report. Facility is licensed as a residential care facility for the elderly. Their plan of operations addresses the care and supervision of seniors who may have dementia. 87101 Definition(r)(5) "Residential Care Facility for the Elderly" means a housing arrangement chosen voluntarily by the resident, the resident's guardian, conservator or other responsible person; where 75 percent of the residents are sixty years of age or older and where varying levels of care and supervision are provided, as agreed to at time of admission or as determined necessary at subsequent times of reappraisal. Any younger residents must have needs compatible with other residents. As exception requests must be requested and approved before admissions, the licensee is currently out of compliance. For the requests to be reviewed further the licensee will provide the following information: Report continued. Exception requests for R2 and R3. Care and supervision of residents with neurologic illness, mental health diagnosis or severe cognitive impairment, including behavior management and safety awareness • Assistance with activities of daily living (ADLs), including care for non-ambulatory residents addressing cognitive and physical issues. • Medication management and administration, including monitoring for side effects and ensuring compliance • Emergency preparedness and evacuation procedures if other that currently on file that address current resident distinct needs. • Mental health training, including recognizing and responding to symptoms associated with conditions such as schizophrenia and traumatic brain injury In addition, we need the administrator to provide us with updated program plan for the following: In addition to staff training, you must provide documentation demonstrating the following- • A staffing plan that clearly outlines how staff will meet the increased supervision and care needs of all residents at all times • A written plan describing how compatibility among residents will be maintained, including supervision strategies and daily structure • Current physician’s reports and updated assessments for all residents to ensure care needs are accurately identified and addressed • A plan to ensure ongoing monitoring of residents’ changing needs and staff responsiveness. Plan for ensuring the care and social needs of residents Licensee will need to submit the above documentation to you for your review. Approval of the exception request will be contingent upon Licensee ability to demonstrate that the facility can provide adequate care and supervision to all residents without compromising health and safety. Deficiencies are noted. Report reviewed and copy provided.the state’s words, verbatim · CDSS document, May 14, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87455 · Plan of correction due date: May 29, 2026

Acceptance and Retention Limitations (b)(8) Persons who are under 60 years of age whose needs are compatible with other residents in care, if they require the same amount of care and supervision as do the other residents in the facility. This requiremtn was not met based on observations and records finding residents under 60 without an exception before admission. This posed a potential risk to residents.the state’s words, verbatim · CDSS document, May 14, 2026

Plan of correction: Liensee will submit additional exception requests and the information requested in this report by the POC date of 5/29/26.

Type of visit: Case Management - Other

On 12/15/25, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit while delivering complaint findings and met with Administrator . 12/9/25, the department received a death report of R1's passing on 12/8/25 while in caret. Records review found R1 was diagnosed with hypertension and congestive heart failure. On 10/12/25, R1 experienced a fall and was seen at the hospital. Since that time, it was reported that R1 experienced decline in alertness and nutrition. While R1 had frequent family involvement, Administrator reported observed decline to family of R1 but not to R1's primary physician . Therefore, licensee did not ensure that such changes are documented and brought to the attention of the resident's physician in a timely manner. As a result of this inspection, the following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed. Copy of report and appeal rights providedthe state’s words, verbatim · CDSS document, Dec 15, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Dec 16, 2025

Observation of the Resident- The licensee shall ensure that residents are regularly observed for changes in ... and that appropriate assistance is provided when such observation reveals unmet needs. When a physical health condition are observed, the licensee shall ensure that such changes such as unusual weight gains or losses or deterioration of mental ability or changes are documented and brought to the attention of the resident's physicial. This requirement was not met based on report, interview and records review. This posed an immedicate risk to R1.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: Licensee agreed to submit a copy of precedures for documenting obserbed changes in residents and the actions to be taken in response to the changes (including notification of physicians). This POC will be submitted by 12/16/25.

Type of visit: Case Management - Other

On 10/22/25, LPA Kevin Mknelly and LPM Maribeth Senty conducted a case management visit and met with Darius Stir. 2 care givers are present for the 4 residents resent. Items discussed: Bedroom 3 recently had a door added for future non-amb fire clearance. A permit was not in place for the work done. Licensee had previously agreed to hire administrators for his two homes. For various reasons the issue is not resolved. Licensee will submit a proposal to the department by 10/29/25. Darius was notified that annual fees have been due since 10/20/25. Darius agreed that fees will be paid today. Other issues discussed- 602s and care plans to be maintained and updated as frequently as needed for resident's current conditions. Training to occur for conditions of residents (i.e. mental health training). As a result of this a deficiency is noted. Report reviewed. copies of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 22, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(a) · Plan of correction due date: Nov 14, 2025

Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met based on statements and records. This posed a potential riskthe state’s words, verbatim · CDSS document, Oct 22, 2025

Plan of correction: Licensee will submit proof of permit for the door for rm.3 by the POC date of 11/14/25.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 9/16/25 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Administrator arrived to assist LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA reviewed (4 ) resident and ( 2) staff files. Resident file deficiency noted, staff training documentation discussed relative to PIN 23-16- ASC and regulation updates 2025.. LPA requested the following documents to update the facility file: Liability insurance, Room 3 door building permit, Administrator designation and Certificate. As a result of this visit, The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Exit interview conducted with Samantha and copy of report (and appeal rights) left at the facility.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: Case Management - Incident

On April 1, 2025, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management and met with Administrator . The purpose of the visit was to follow up on the visit dated March 27, 2025. The incident under investigation involves that, on 3/17/25, the department received an incident report for R1's fall with injury requiring hospitalization, on 3/14/25 at approximately 8:30 PM. While hospitalized, R1 was diagnosed with a hip fracture and to have contracted c-diff. R1 returned to care with Hospice, on 3/16/25. R1 passed away on 3/23/25. On March 27, 2025, LPA interviewed Administrator, S1 and R1 as well as requesting records. Administrator and S1 stated that R1 fell on 3/14/25 while using a walker and tripped on the way to the bathroom. Other interviews found that R1 fell while not using a walker. Additionally, at the time of R1’s fall, live-in caregiver was in the shower and unable to hear R1’s roommate, R2, calls for assistance. R2 got out of bed after R1 fell and went to alert S1 to R1’s fall. Following review of records and additional interviews, the department issued the following findings. Report continued R1 was admitted to the facility on February 28, 2025. At the time of admission, R1’s 8/19/24 physician’s assessment listed R1 as having , major neurocognitive disorder, documented as ambulatory, had a prescription for melatonin 5 mg. "half hour before bedtime”, audio impairment, visual impairment, bowel and bladder impairment and motor impairment. R1’s appraisal completed by facility staff on 3/3/25 noted: trouble walking, sometimes trouble speaking coherently, confusion/ forgetfulness, Non- Ambulatory, unable to walk without physical assistance, frail/slow, "Total Care", help with bathing, dressing and moving about the facility. The physician’s assessment does not identify R1’s extent of sleeplessness ,nor does the needs and services address a fall risk intervention for R1. R1 had sustained a prior fall with injury on 3/9/25. Incident report submitted stated that R1 had rolled out of bed and hit their head. Hospital discharge summary stated that R1 sustained a cervical spine injury for which R1 was to wear a neck brace for 10 days. Statements collected found R1 was not compliant to wear the brace. In addition to lack of supervision for R1’s safety needs, it was found that: R1 had an appraisal/ needs and services plan dated 3/4/25 that identified hospice serves, however, R1 did not start hospice services until 3/16/25, R1 has a prescription for Melatonin to be given at a half hour before bed though medication records logged melatonin given at 4 PM; and overnight staff have a room on the second floor but there is no signal system in place for residents to call for assistance if needed. Report continued. Due to a physician’s report that was not current to R1’s level of care, resident records lacking required information and staffing insufficient to monitor R1’s safety, The Administrator did not fulfill their duties as required. As a result of this investigation, the following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. A $500 civil penalty was assess. Further civil penalty may me reviewed/ assessed. Report reviewed. Copy of report and appeal rights providedthe state’s words, verbatim · CDSS document, Apr 1, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(b)(2) · Plan of correction due date: Apr 2, 2025

Care of Persons with Dementia (b) Licensees shall be responsible for the following: (2) For facilities with fewer than 16 residents, ensuring there is at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal, or observation, to require awake night supervision. This requirement was not met based on based on records and statements. This posed an immediate risk to R1.the state’s words, verbatim · CDSS document, Apr 1, 2025

Plan of correction: Licensee wiil review the current care needs of residents and submit a staff schedule to reflect sufficient staffing for resident needs and caregiver on duty by the POC date of 4/2/25

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(i)(1) · Plan of correction due date: Apr 2, 2025

Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system… This requirement was not met based on observations and statements. This posed an immediate risk to residents.the state’s words, verbatim · CDSS document, Apr 1, 2025

Plan of correction: Licensee will submit a plan for facility signal system for residents to effectively call for staff assistance when the sole staff present is on the second floor of the home by the POC date of 4/2/25

Type of visit: Case Management - Other

On March 27.2025, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management and met with Administrator. On 3/17/25, the department received an incident report for R1's fall with injury requiring hospitalization. Additionally, R1 returned to care with Hospice. R1 passed away on 3/23/25. LPA interviewed Aministrator, S1 and R1. LPA reviewed R1's records and requested Administrator forward the following records for R1 to LPA: ID/ Emergency contact, LIC 602, Pre-appraisal and Appraisal- Needs and Services Plan. Records to be submitted by 4/2/25. As a result of today’s inspection, no deficiencies were noted at this time. Report reviewed. Copy of report providedthe state’s words, verbatim · CDSS document, Mar 27, 2025

Type of visit: Case Management - Other

On 12/30/24, Licensing Program Analyst (LPA) Kevin Mknelly, and met with Administrator, Shavel Williams. Samantha Shaw was also present. Licensee is in process of increasing non-ambulatory capacity for an additional, previously ambulatory only, room. LPA inspected the home to insure ambulatory occupancy in the room under review. Fire safety measures are in place. Licensee is still completing Fire Marshal requirements for the increase. As a result of today’s inspection, no deficiencies were noted. Report reviewed. Copy of report providedthe state’s words, verbatim · CDSS document, Dec 30, 2024

Type of visit: Office

On 11/26/24, an in office Non-compliance conference was held. Present were: Regional Manager, Alycia Rayner, Licensing Program Manager, Maribeth Senty, Licensing Program Analyst, Kevin Mknelly, Administrator, Darius Stir(representing licensee Madison Square Senior Living LLC). A non-compliance plan was developed with the licensee on today's date as it relates recent compliance history. The licensee was in agreement with the drafted non-compliance plan. No new citations are issued as a result of today's meeting. Documents to be emailed and signed copies returned.the state’s words, verbatim · CDSS document, Nov 26, 2024

Type of visit: POC

On 10/31/24, LPA Kevin Mknelly met with caregiver to conduct a Plan of Correction (POC) visit. Administrator was contacted by phone by LPA and informed of the reason for the visit. In conversation by LPA ,with the Administrator, Administrator stated that updated LIC 602s for identified residents have not been completed yet ,nor have appointments been made. On 10/9/24 the following citations were issued with plans of correction dates by 10/25/24: 87458(b)(1) Medical assessments- requires a physical assessment by a physician. It was found that 2 residents' LIC602s did not contain some examination information and were conducted remotely by a physician assistant (PA). Licensee agreed to obtain LIC602s from a physician's physical exam of the two residents and provide copies to LPA by the POC due date of 10/23/24. To date the exams have not been conducted. The POCs may be cleared by confirmed assessment appointments submitted to LPA. Licensee informed in this report that civil penalties may continue to accrue at $100 per day until the citation plans of corrections are completed. As a result of this visit, no additional deficiency is noted. Civil Penalties for failure to correct have been issued. Report reviewed. Copy of the report provided.the state’s words, verbatim · CDSS document, Oct 31, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced on 10/9/24 and met with the Administrator, Darius Stir, and Caregiver, Yanique Dobson, to conduct a Required-1 Year Inspection. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four (4) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 106.6 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA observed the outdoor area and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke and carbon monoxide detectors are operational. Fire extinguisher and first aid kit are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed five (5) resident files and also reviewed one (1) staff file. Per California Code of Regulations Title 22, Division 6, Chapter 8 the following (1) deficiency was observed during today's visit. A citation was issued on the LIC809-D page. Exit interview conducted. A copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 9, 2024

Type of visit: Office

Licensing Program Manager (LPM), Maribeth Senty, and Licensing Program Analyst (LPA), Kevin Mknelly, conducted a remote office meeting with Administrator via Zoom conference to discuss recent compliance issues and offer further assistance if needed. In the meeting today, LPM and LPA reviewed, with Mr. Stir, the citations and advisories issue to the licensee on visits dated 10/31/23 and 11/17/23. All plans of corrections have been completed to date. The licensee is currently in compliance with regulatory requirements. The regional office offered Mr Stir, Technical Support Program (TSP) consultation to further review and advise on medication administration and procedures as well as any other other issues identified with the licensee that may be of benefit to continued success. Mr. Stir accepted the offer. The Regional Office (RO) will submit a request to TSP. As a result of this meeting no deficiencies were cited. Copy of the report provided to Licensee via email with a request for return signed copy.the state’s words, verbatim · CDSS document, Nov 30, 2023

Type of visit: POC

Licensing Program Analyst (LPA) Kevin Mknelly arrived on 11/28/23 for the purpose of conducting Plan of Correction (POC) inspection for deficiencies issued on 10/31/23. LPA was greeted by caregiver. Administrator arrived to assist with the visit. On 10/31/23 deficiencies were cited for resident and staff files being incomplete. LPA reviewed 4 resident files and 2 staff files. All files reviewed were complete for required documents. A new resident was admitted on 11/27/23. That file was in process of being assembled and was not reviewed by LPA. As a result of this visit, the plans of corrections (POC) are cleared and POC letters provided. No deficiencies are sited as a result of this visit. An exit interview was conducted with caregiver, MS. A copy of the report was providedthe state’s words, verbatim · CDSS document, Nov 28, 2023

Type of visit: POC

Licensing Program Analyst (LPA) Kevin Mknelly arrived on 11/17/23 for the purpose of conducting Plan of Correction (POC) inspection for deficiencies issued on 10/31/23. LPA was greeted by caregiver. LPA spoke with the Administrator by phone. On 10/31/23 deficiencies were cited for a fire clearance and a criminal record clearance violation. At this time, clearance issues are resolved and all staff have verified clearance to work at the facility. R2 continues to reside in a room fire department cleared for ambulatory residents only. This failure to correct has exceeded 10 days therefore the citation is to be reissued without civil penalty for the failure to correct. LPA discussed annual fees past due on 10/31/23. The fees have not been paid at this time, therefore a citation is issued. Administrator is still in process of correcting resident and staff file issues cited. The plan of correction dates for those deficiencies is 11/21/23. LPA also advised Administrator to have LIC 308 designations of staff in place for times they are not present. An exit interview was conducted with caregiver, MS. A copy of the report was provided and appeal rights were given. Licensee/Administrator to submit Plan of Corrections by due date. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.the state’s words, verbatim · CDSS document, Nov 17, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(1) · Plan of correction due date: Nov 18, 2023

(a) All facilities shall maintain a fire clearance approved... Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify ... (1) Nonambulatory persons. This requirement is not met as evidenced by: Based on observation and records review, the licensee did not comply with the section cited above in1 of 1 residents (R2) currently is non-ambulatory residing in a room cleared for ambulatory only which poses an immediate health, safety or personal rights risk to persons in care. This poses an immediate risk to residents.the state’s words, verbatim · CDSS document, Nov 17, 2023

Plan of correction: Licensee will provide proof that R2 has been moved to a room cleared for non-ambulatory residents by the POC date of 11/18/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87156(a) · Plan of correction due date: Nov 20, 2023

Licensing Fees (a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. This requirement was not met based on records and interview.the state’s words, verbatim · CDSS document, Nov 17, 2023

Plan of correction: Licensee will submit proof of payment to CCL by the POC date of 11/20/23.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 10/31/23 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with Caregiver and explained the purpose of the visit. Administrator was notified and arrived to assist. LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured the following issued were discussed and plans of correction established: R2 is non-ambulatory yet resides in a ambulatory only room. Licensee will make arrangements to move R2 to a vacant room. LPA discussed the process for modifying room three to be fire clearance compliant for non-ambulatory residents. The complaint poster was not observed. LPA reviewed resident files. 4 of 4 files are incomplete for various required forms. Medication files are also incomplete. LPA reviewed staff files. 2 of 2 files are incomplete for forms and training. S1 and S2 did not have required criminal record clearance for CA assisted living. Arrangements were made to secure clearance and transfer staff to work at the home. As a result of this inspection, the following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Exit interview conducted. Report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 31, 2023

The state marks this report as 16 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.