Routine inspection·September 20, 2024

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year inspection. LPA met with Administrator Jae Wan Rim. LPA confirmed Administrator has a current Administrator Certificate which expires on 05/15/2026 The facility is operating within capacity limitations. Facility currently has 167 residents in care of which six residents are under Hospice care. Community is mostly Korean speaking residents. LPA observed residents walking around socializing, or relaxing in their respective rooms. In-House Doctor was present seeing residents during today's visit. Residents were observed clean, content and well taken care of. LPA observed the facility to be clean and in good repair. LPA observed new flooring on first floor is being installed. Facility provided notice to CCL prior to start of installation. The facility is maintained at a comfortable temperature. Lighting is sufficient for safety and comfort. Patio has a covered area with seating for residents and visitors. Hygiene items were observed to be readily available for residents in care. Hot water was found to be within regulatory requirements. Grab bars were found available in restrooms used by residents. As this is a multi-level licensed structure, a signal system was found in place, tested and functional. Annual Fire Inspection reports and Fire Prevention Services documentation was available for review. Records of Maintenance and Emergency Drills were available for review, last being 07/04/2024. Sprinkler system was inspected and documentation was reviewed. LPA, along with AD Rim toured and inspected the kitchen, reviewed lunch service and reviewed monthly dietician's inspection reports. Last dietician's report and sanitation survey form was dated 09/06/2024. Dietician provided in-service training in area of menu availability for Korean residents was observed. LPA observed menu posted in English and Korean. LPA observed a one week supply of nonperishable foods and two days of perishable foods. Pesticides and other toxins are stored away from food areas of the kitchen. Sharp items are also kept inaccessible from residents. LPA also observed adequate Care and Supervision for the number of residents in care. (cont...LIC809C) Medications are centrally stored and inaccessible to residents in care. LPA observed medication is pre-poured for 3 days. LPA observed resident centered activities posted. LPA conducted interviews with residents and staff. LPA reviewed 16 resident files and 5 staff files Based on observations made during today's visit, deficiency is being cited per Title 22. An exit interview was conducted with Administrator and a copy of this report (LIC809, LIC809D and Appeals Right) was sent to email on file.