Routine inspection·October 10, 2023

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection on 10/10/23. LPA contacted the administrator, Eunice Kim, who arrived shortly after to allow entry. There is currently no resident residing at the home. The facility is licensed for 6 residents ages 60 and over. There may be (4) ambulatory and (2) non-ambulatory residents. The non-ambulatory is approved for room #1 only. There is a hospice waiver approved for 6 residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools to assess the facility. The one story home consists of 4 resident bedrooms, 2 bathrooms, living room, dining room, kitchen, and attached garage. There is a swimming pool in the backyard and is secured by a fence. There are no items obstructing the walkways. There are smoke and carbon monoxide combo detectors located in each room and hallway. The bedrooms are adequately furnished and ready for move-in. The resident medications will be stored in a locked cabinet located in the dining room. The fireplace is not in use and is adequately screened with a lock. There are surveillance cameras around the common areas. Facility has non-perishable items in storage and per administrator, she will purchase perishable items when they receive their first resident. The administrator's certificate expires on 5/15/24 and has current CPR & First Aid certificate. Facility has the updated LIC610E Emergency Disaster Plan with the emergency procedures posted. The facility maintains liability insurance covering the $1,000,000 per occurrence and $3,000,000 in annual aggregate. There are no deficiencies issued today. A technical violation was given. An exit interview was held and a copy of this report was given to the administrator.