Routine inspection·August 11, 2023

Licensing Program Analyst (LPA) Jose Villalobos, conducted a required annual inspection using the Inspection Tool. LPA met with Administrator Tae Hyung Kim and the purpose of the visit was discussed. Structure/Physical Plant: The facility is part of a single story home located in a residential area and contains the following: living room, dining room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, locked storage cabinet for medications and sharps, (4) resident rooms, (2) bathrooms for residents; bathrooms with shower, toilet and washbasin. A back yard with shaded area and seating for resident use. A connected garage inaccessible to clients for storage and Laundry; with washer and dryer. The residence is equipped with air conditioning. There is a inaccessible fireplace and gated pool inaccessible to residents. Accommodations : Adequate accommodations observed throughout facility. Hallway and Doorways: Free and clean of obstruction and debris. Resident Rooms: All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. Bathrooms: All bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Linens & Hygiene Supplies: Required linen/supplies observed. Emergency Phone Numbers, Exit Plan & Menu: Facility has a working phone landline. There is a cordless phone for resident use. Fire Extinguisher observed Food Service: All food and adequate utensils such as, dishes, cups, bowls and plates observed. Smoke Detectors & Fire Extinguishers: Detectors Electrical & connected. Battery operated & working, all detectors tested and operational. Toxins: Locked/stored for staff use only. Hot Water Temperature: Measured between 105 -110 degrees all around the home. Medications, First-Aid Kit & Book: Medications centrally stored and inaccessible to residents. First aid kit observed. Postings: Required wall postings observed. Residents & Staff Files : LPA reviewed (3) of (3) Resident medication records and files , as well as three (3) Staff Files . Emergency Disaster Plan observed. Plan of Operations Observed. Inspection tool completed and, per Title 22, deficiencies are being cited. See 809-D page. Exit Interview conducted and a copy of this report and appeal rights discussed and provided.