Routine inspection·July 1, 2025

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Orlando Halili caregiver for the facility, and explained the purpose of the visit. Administrator Tae Kim arrived shortly thereafter. There are one (1) ambulatory and one (1) non-ambulatory residents residing within the home. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) non-ambulatory residents over the age of sixty (60), of whom one (1) may be on hospice. The facility consists of a kitchen, a dining room, a living room, a laundry room, an attached garage, a caregiver room, four (4) resident bedrooms, and two (2) restrooms which had hot water temperature readings of 105.6 Degrees Fahrenheit, 110.4 Degrees Fahrenheit respectively. Facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has multiple fully charged fire extinguishers kept in the facility. Operational Requirements: · Fire clearance was approved by LA County Fire Department for a capacity of six (6) non-ambulatory residents over the age of sixty (60), of whom one (1) may be on hospice. · Care and supervision to meet the clients’ needs was observed. · It was discovered that one (1) resident had passed away approximately a week ago, however death report has not yet been submitted to Community Care Licensing Division (CCLD). Staffing: · Three (3) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Three (3) staff files were reviewed for criminal background clearance and training. · Three (3) staff records reviewed have a health screening with a Tuberculosis clearance, and staff have First Aid/CPR trainings that are active. · Two (2) staff members did not have required annual training on the topics of dementia care, hospice care, postural supports, and restricted health conditions documented within the past year. · The administrator’s certificate expires on 8/21/2025. Resident Rights/Information: · Physician orders were reviewed for two (2) residents. · Medications were also reviewed for two (2) residents. Resident Records/Incident Reports: · Two (2) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was posted in the facility. · The last emergency and disaster drill was conducted on 3/29/2025. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. · One (1) resident on hospice does has full bed rails, however they do not have a physician’s order for the rails. Administrator stated he will obtain the order from hospice. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit is documented on the LIC809D pages. Exit interview held and a copy of the report along with appeal rights will be provided by email.