Routine inspection·November 19, 2024

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection on 11/19/24. LPA met with Staff, Hyo Kwak, and explained the reason for the visit. Administrator, Eunice Kim, arrived shortly after to assist with the visit. The facility is licensed for 6 residents ages 60 and over, of which 2 may be non-ambulatory. There is a hospice waiver approved for 6 residents. LPA toured the facility and observed the following: The facility is a single family home consisting of 4 resident bedrooms, 1 staff office behind bedroom #1, 3 bathrooms, living room, dining area, kitchen, and attached garage. The backyard has an area for gardening and relaxation. There is swimming pool on the premises. There are an operable carbon monoxide detector and smoke detectors throughout the facility. The hot water temperature was measured within the required range of 105-120 degrees F. The fireplace is secured by a locked gate. There is sufficient space for indoor and outdoor activities. Staff are cleaning and disinfecting the facility at least once a day. The facility has surveillance cameras in the common areas. Facility has sufficient food supplies, 2 day perishable and at least a week of non-perishable items. Lunch and dinner are catered from a local food vendor. Facility accepts and retains residents with dementia. Staff are ensuring that incontinence residents are changed often and the facility remains free of odor from incontinence. LPA reviewed the 4 Staff and 5 residents files today. Staff files are complete and have current CPR & First Aid certificates. They also have the sufficient number of hours for dementia care training. All the resident files have the admission agreement, medical assessment with TB results, consent forms, property valuable form, and Appraisal/Needs and Services Plan. Medications are centrally stored and inaccessible to residents. LPA reviewed all 5 residents' medications and they are being given as prescribed by the physician. Information for appropriate reporting agencies are posted at the facility. Residents' rights are respected and implemented by staff. The Emergency Disaster Plan is posted with contact numbers and at least 2 relocation sites. No deficiencies were issued today. However, technical assistance were given. An exit interview was held and a copy of this report along with appeal rights are given to the administrator.