Follow-up on corrections·June 30, 2023

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Case Management Visit on 6/30/23 at 8:35 am to issue a $500 civil penalty. LPA Ramirez was greeted by Licensee/Administrator Jung Kim and LPA explained the purpose of the visit. Case Management Findings: On 6/25/23 RM Ramirez and LPA Ramirez conducted a Case Management visit to perform a health and wellness check on residents in care and to gather information regarding the two (2) recent deaths of Resident #1 (R1) and Resident #2 (R2) on 06/24/23. Copies of pertinent documents for Staff #1 (S1) and interview of staff on 6/25/23, revealed Licensee Jung Kim failed to obtain required criminal record clearance or a criminal record exemption from the State Department of Social Services before S1’s gainful employment at the facility, direct contact with residents in the facility and residing in the facility. Medication Administration Record (MAR) for the month of June 2023 for R1 and R2 appear to record S1’s signature/or initials starting 6/1/23 and on various other days till 6/23/23. LPA Ramirez compared MAR to “Staff Annual Education, Staff Continuing Education, Staff Initial Training, and On-Site Orientation sheets S1 signed/or initialed by S1 and recorded in S1’s facility personnel file. Interview with Licensee Jung Kim on 6/25/23 revealed S1 began employment at the facility on 6/1/23 however, the State of California Department of Justice did not formally issue a DOJ APPLICANT FINGERPRINT RESPONSE letter clearing S1 till 6/16/23. It was revealed S1 worked at the facility without criminal background clearance for a total of fifteen (15) days. A $500 civil penalty is being issued. Exit interview is being conducted with Licensee Jung Kim and a copy of this report, 809-D, LIC 421BG, and appeals rights was provided.