Routine inspection·September 6, 2024

On September 6, 2024, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced annual required visit. LPA met with administrator Ki Hwan Kim and explained the purpose of today’s visit. The facility is licensed to operate for (6) non-ambulatory elderly residents ages 60 and above. The facility is approved for (1) hospice resident. There are currently five (6) residents in care. Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident's rooms, six (6) bathrooms, a living area, a dining area, a kitchen, and outside patio area. Physical Plant: LPA toured the physical plant. All rooms were inspected. LPA observed the facility to be furnished at time of visit with ample seating for the Residents in care. There is adequate lighting in the facility and the temperature was comfortable 75 degrees F. Hallways and passageways were free of obstruction. A working landline telephone remains available. Bedrooms LPA inspected all six (6) bedrooms. All bedrooms were observed to have the required furniture including beds, dressers, nightstands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting. page 1 of 3 Bathrooms LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The shower had a nonskid material in bottom and shower chair. Resident’s toiletries are secured in a cabinet under the sink. The water temperatures measured 108.9, 107.9,110, and 106 degrees Fahrenheit respectively. The toilet and faucets are operational. Both bathrooms were observed to be clean, in good repair and within Title 22 regulations. Linens & Hygiene LPA observed all beds to have the required linens including mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed an ample supply of linens, towels, and blankets in the hall closets. LPA observed incontinence care products stored in the supply area. LPA observed an extra supply of hygiene products secured in the garage and in the supply area of the home. Kitchen/Laundry Room LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, washer, dryer, refrigerator, and additional freezer. LPA observed an ample supply of cutleries, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in a mental locked in the kitchen and are inaccessible to residents. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. All food was properly stored and labeled. Additional food and water located in the attached garage where there is an additional refrigerator and freezer. Page 2 of 3 Infection Control Practices: During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted LPA observed all required postings: Personal Rights, Ombudsman information poster, see something say something poster, facility sketch, California employee wage information (Federal and State), menus and activities. LPA observed that there are fully stocked First Aid Kit supplies in the home. Medications LPA observed all centrally stored medications in their original packaging and are secured in a locked cabinet in the kitchen area. Files LPA reviewed six (6) resident files and found they contained all the necessary documentation. LPA reviewed four (4) staff files and found they contained the required documentation. LPA reviewed copies of Client Roster, Staff Roster, Emergency and Disaster Plan (LIC610E). Liability Insurance expires on 08/1/2025. The facility has 6 fire extinguishers, and 11 operable smoke detectors/carbon monoxide combination. The detectors are interconnected and can be heard throughout the facility. LPA issued Technical Advisory notes during this visit. An exit interview was conducted with licensee and a copy of this report was provided Page 3 of 3