Routine inspection·September 13, 2025

On September 13, 2024, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced annual required visit. LPA met with administrator Ki Hwan "Tony" 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 (6) 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 Lee and Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (6) bedrooms and (6) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. The water temperature ranged from measured between 105 and 120 degrees F. Page 1 of 3 Bedrooms LPA inspected all six (6) bedrooms. All bedrooms were observed to have the required furniture including beds, dressers, night stands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting. 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 measure between 105-120 degrees F. 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 2-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 Safety During the visit, LPA observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. All fire extinguishers were fully charged all bought within 1 year. The last Fire/Disaster Drills were conducted on 8/5/25 Files and postings: LPA reviewed 6 resident files and found 6 out of 6 contained all the necessary documentation. LPA reviewed 3 staff files and found 3 out of 3 contained the required documentation, certification, and training. LPA observed all required posting throughout the facility. General Liability current: expires on 7/31/26 Medication LPA observed all centrally stored medications in their original packaging and are secured in cabinet in kitchen. There were no deficiencies during today's visit. An exit interview was conducted with licensee and a copy of this report was provided to Licensee Ki Hwan "Tony" Kim. Page 3 of 3