Routine inspection·July 16, 2021

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced annual inspection focus on Infection Control Domain. LPA was assisted by Staff Charito Timbreza, who stated began working on June, 2021 at this facility. LPA discussed the purpose of the visit and calls were made by staff and LPA to inform Administrator of the visit. Administrator Taehyung Kim arrived at 11:20am to complete the visit with LPA At 9:40 am LPA was allowed entry to the facility by staff Charito and LPA was screened and signed in. LPA was assisted by staff during walk through and Infection control domain questions. The home The facility is licensed to serve (6) residents of which up to (6) may be non ambulatory. No on site staff room. 24 hour awake staff required, hospice waiver granted for max of 1 resident. The facility is a single story 4 bedroom, 2 bathroom home located in a residential neighborhood. Each resident bedroom has the required furniture, equipment and supplies, including bed, linen supply, storage space, lighting. There is sufficient light in the hallway. The hot water measured at 111 degrees Fahrenheit in restroom. There is an outside shaded activity space. The smoke detectors and carbon monoxide detectors were tested and operational. The pool is surrounded by a 5 foot fence with self latching gate. Medications were locked and inaccessible to residents. Staff and client files were reviewed between 11:20am-12pm. Exits and passageways are free of obstructions . Yard is free of hazards and debris. No deficiencies were cited on todays visit. Exit interview was conducted with Administrator Taehyung Kim and copy of this report was provided.