Routine inspection·August 15, 2022

Licensing Program Analyst (LPA) Jose Villalobos made and unannounced Annual inspection focused on Infection Control. On today’s visit LPA met with Administrator Taehyung Kim . The purpose of the visit was discussed. As a part of the inspection, LPA used the inspection tool, reviewed three (3) resident records, three (3) staff files, and three (3) resident medications. Currently the facility has (3) residents which (2) are non-ambulatory. Facility is a one story family home with four (4) resident bedrooms, two (2) bathrooms, living room, kitchen, central air and heating, dining area, laundry room, a shaded area located in the backyard. an attached garage inaccessible to residents. Front and back yard is in good condition at time of visit. Facility has a fireplace blocked from resident use. There is a pool in the backyard fenced in and locked. Washer/Dryer appliances observed. Toxins and sharps locked and inaccessible to residents. Bedrooms #1-#4 required furnishing. Bathroom have a working toilet, wash basin, and shower. Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies were observed. Fire alarms are interconnected and operational. Required postings observed. Water temperature within required tittle 22 regulations. Infection control domain completed and there were no deficiencies. An exit interview was conducted and a copy of this report was provided.