Facility Evaluation Report

On 10/10/2025, at 11:15 AM, Licensing Program Analyst (LPA) James Sampair arrived for this announced visit of the facility. Upon entry, the LPA verified the purpose of the visit with Administrator (ADM) Donald Hay.

The LPA and ADM met concerning the fire inspection required for th e change in capacity of this facility after the expansion of the facility. To request the required inspection, the LPA submitted an STD 850 to the Contra Costa County Fire Protection District at 12:15 PM.

During a tour of the facility at approximately 12:00 PM, the LPA observed 9 residents living in the facility. This puts them over capacity by 1 resident for which they have been cited. The Licensee will submit a written plan on or before 10/17/2025 concerning the way in which staff will safely care for residents in case of an emergency or disaster until the licensed capacity of their facility has been increased to 12 residents in accordance with their 6/17/2025 request to the Community Care Licensing Department.

1 Type-B citation was issued during this inspection.

Deficiencies are cited from Title 22 California Code of Regulations (refer to LIC 809-D). Failure to submit

proof of correction may result in civil penalties being issued.

Exit interview conducted and a copy of the Appeal Rights, and this report provided.