Routine inspection·May 22, 2025

Licensing Program Analysts (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:36 AM. LPA spoke on the phone with Administrator Kyong Suk Lee who informed LPA that the facility currently has no residents. Administrator arrived to the facility at 11:23 AM. Beginning at 11:25 AM, the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher was fully charged and recently serviced on 05/20/2025. Combination smoke and carbon monoxide detectors were tested at 12:30 PM and all were functional at the time of the visit. No fire clearance concerns were observed. KITCHEN/GARAGE : The LPA observed the garage to be locked and inaccessible. The garage was observed to contain the facility washer and dryer along with tools, care supplies, and household chemicals. The kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable food. No perishable food was observed. Cleaning supplies are located in a locked under-sink cabinet. Medication cabinet was observed to be locked. COMMON AREAS : This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. The living room contained a television. The dining area contained a locked cabinet that contains facility files and adequate seating for resident use. The entryway contained required postings and an infection control point. Continued on LIC 809C. BATHROOMS : There are two (2) bathrooms for resident use. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms and all were properly secured. The water temperature was measured in resident bathrooms to be between 129 and 132.8 degrees Fahrenheit. BEDROOMS : There are 4 (four) total bedrooms in the facility. Three (3) bedrooms were observed to be single occupancy rooms. Bedroom #1 was observed to be missing a bed. All other resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. OUTDOOR SPACE: The backyard has patio furniture including a table and chairs for resident use but is not covered. There were no bodies of water on the premises. The entryway ramp and exit ramps located at the back of the facility were observed to lack appropriate safety railings. EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's emergency disaster plan. The plan is reviewed/updated annually by the facility’s Administrator. Due to no residents in care no citations were issued. Although advisory notes were issued to the licensee. Exit interview conducted and report was issued.