Routine inspection·March 23, 2026

This report supersedes previous report, It is being changed to correct type of visit and nothing else has changed. Licensing Program Analyst (LPA) Alberto Lopez conducted an announced annual inspection visit and met with Ilki Baek, Caregiver, and discussed the purpose of the visit. . The facility has an approved fire clearance for 11 non-ambulatory residents, and three (3) bedridden residents. The facility is a single-story home: 9 bedrooms, and 7 bathrooms, dining/ living room, backyard with detached garage used for laundry and storage, located in Alhambra, CA Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has sufficient PPE supplies, an Infection Control Plan. Bathrooms have hand washing signs, soap and paper towels. Facility Administrator is adhering to infection control requirements. Operational Requirements: Facility has proper fire clearance and shaded area for activities. Staffing : There is sufficient staffing at the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records-Training : Staff files are maintained at the facility. LPA reviewed staff files for Facility Administrator, and S1-S3. Staff have current CPR/first aid training and sufficient on-going training that meets the annual requirement. Staff have their Health Screening and Tuberculosis Screening on file. Staff are also trained in Abuse Reporting. Administrator Certificate expires on 09/08/2026. (Continued on 809C) (continued from 809) Resident Rights-Information: resident personal rights and House Rules are posted. Per Facility Administrator, facility provides wi-fi services for facility residents. . (Continued on 809C) Resident Records-Incident Reports: LPA reviewed resident files for C1 through C4. Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Appraisal Needs and Services Plan, Functional Capabilities Assessment, Mental Health Intake Assessment, Client Cash Resources. Special Incident Reports, Client Personal Property and Clients Personal Rights. One resident’s Pre-Admission Appraisal is blank. Details provided to Licensee. Food Service: The facility has sufficient food supplies of 2-day perishable and 7-day supply of non-perishable items. The food is properly stored in the refrigerator, which is clean and well maintained. There are no clients with special diets residing at this facility. Kitchen is kept clean and free from rodents and other bugs/ insects. Plates, cups and utensils are kept clean and stored properly. Several cans of food are expired and were immediately discarded. Health Related Services : The medications are centrally stored and in their original containers. LPA reviewed medication for R1-R4. The facility uses the Medication Administration Record (MAR) log to document medications given. All medications are not administered as prescribed by the Physician. Some medications do not have orders, and some do not have labels. Details provided to Licensee for corrections. Incidental Medical Services: Per Facility Administrator, there are no residents at this home with incidental medical services or restricted health condition. Emergency Intervention: Not Applicable. LPA will return to complete 2 other domains on another day. Deficiencies noted. Technical violation issued. Exit interview and a copy of this report, appeal rights were provided.