Routine inspection·March 6, 2024

Licensing Program Analyst (LPA) Sanjay Vaid conducted an unannounced Required- 1 year visit. LPA met with Administrator David Kim and explained the purpose of the visit. There are 10 residents ages 60 and above [7 ambulatory, 3 non-ambulatory, & 3 bedridden]. A Dementia waiver and an approved hospice waiver for 6 residents is in place. Facility is a single-story home consisting of 11 resident bedrooms, 7 bathrooms, living room, dining room, tv room kitchen, indoor patio, laundry room, two (2) shaded patio areas, and detached garage. Administrator certificate expires 3/9/2024. The following were observed/inspected: • Five (5) resident files were reviewed [Physician's Report, admission agreement, ID/emergency information, negative test result for tuberculosis, Appraisal/Needs and Services Plan]. • Smoke detectors and carbon monoxide detectors were tested and are operable. Four fire extinguishers are fully charged. Last fire drill was conducted on 01/03/2024. • Sufficient supply of extra linen, towels and personal hygiene supplies are available. • Resident rooms had the required furniture and a comfortable temperature was maintained for residents. • Hot water temperature readings were within 105-120 Degrees Fahrenheit. • Auditory alarms were operable on exit doors. • Centrally stored medication records were observed. Medications were reviewed at 12:30 PM. • Four (4) staff files were reviewed. Staff have criminal record clearance, TB clearance, & staff training. • Staff responsible for direct care and supervision have valid First Aid/ CPR certificates. • Bathrooms are clean and fully operational with hand rails and non skid mats and shower chairs • Refrigerator appears sanitary with required temperature maintained. • Sufficient supply of perishable for 2 days & non-perishable foods for 7 days. • Cleaning agents are inaccessible to residents under the locked kitchen sink. • First Aid kit and Manual were inspected. • Side and rear yard areas had is clear from debris, no obstructions observed. Exit interview was conducted. A copy of this report was provided to Administrator David Kim.