Routine inspection·November 4, 2021

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Administrator Haeryun Cho and explained the reason for the visit. Administrator Haeryun Cho has an administrator certificate expiring on 06/14/2023. At 11:00 AM, LPA toured the facility with Administrator Cho. Facility is two stories with licensee living quarters on the second floor. Facility has five residents in care during today's visit, with one on hospice care. LPA observed residents relaxing in the facility. At 11:05 AM, LPA toured the unlocked garage and observed unsecured medications in the auxiliary refrigerator as well as unsecured cleaning supplies. Facility appears clean and sanitary. All resident's rooms had required elements as well as restrooms stocked with soap/ sanitizer. LPA observed three out of five residents are sleeping on mattresses on the floor without a bed frame. At 11:10 AM, LPA observed Resident 2 has full bed rails on the bed but no documentation of hospice care as well as unsecured cleaning items in the common restroom adjacent to resident's room. LPA observed the screening/ sanitizing station in the entrance of the facility. Facility takes resident and staff temperatures daily but does not document. Facility has covid precaution postings as well as most required department postings. LPA toured the kitchen and observed ample food supply. At 11:20 AM, LPA observed two drawers and a cupboard contained unsecured medications and one cupboard contained unsecured vitamins and medications. There is a drawer with loose, unmarked medications. LPA observed unsecured cleaning supplies under the sink as well as in a hallway cupboard. Facility staff is using an "Aim and Flame" to start the burners on the cook top. Administrator states the cook top has been disabled from using the knobs to start the burners. Facility has completed the mitigation plan and plan has been approved. LPA observed emergency water as well as the first aid kit which contained all required items. LPA toured the outside grounds and observed the outside visitation area. Exit gate is unlocked and self latching. Residents participate in activities such as exercise and bible study. Facility has ample supply of PPE and cleaning supplies. All staff and residents are vaccinated for Covid-19. At 11:35 AM, LPA reviewed all resident files and CONTINUED ON LIC 809C DATED 11/04/2021 three out of four residents with Dementia do not have an updated physician report. Licensee has been requested to attend an in-office meeting at 770 the City Dr S Orange, Ca 92868 at 11:00 AM on Monday, November 8, 2021. Components of the visit as well as possible additional citations to be discussed at that time. Based on the observations made during today's visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with Administrator Cho and a copy was provided as well as appeal rights.