Routine inspection·July 3, 2024

On July 3, 2024, at 8:00am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (AD) Daniel Yoo and explained the purpose of the visit. The facility is licensed to operate for three (3) ambulatory and three (3) non-ambulatory of which three may be bedridden and have a hospice waiver for three (3) residents. The facility is a two story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living room, dining room, kitchen, swimming pool, jacuzzi, koi pond, attached 2-car garage, staff break area on the second floor, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with AD Yoo. There are no obstructions on the premises. There is a swimming pool, jacuzzi, and a koi pond in the backyard that is surrounded by a fence with two entrances with each entrance having a self-closing latch and opening away from the swimming pool, jacuzzi, and koi pond. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Staff Room 1. The second floor is used for storage and a break area for the staff. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 117.6 degrees F. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Evaluation Report Continues on LIC 809-C . During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The facility conducts Fire/Safety Drill quarterly and was last conducted on April 23, 2024. Emergency food, water, and supplies are stored in the garage. A working telephone (714-340-3315) remains available. The facility has two (2) fire extinguisher that are charged and mounted in the kitchen and on the second floor. All smoke/carbon monoxide detectors were operable. A comfortable temperature of 77 degrees F was maintained in the facility. LPA conducted an audit of resident files (R1-R6), staff files (S1-S4) and medication and medication administration review. LPA Kim conducted 4 staff interviews. A technical violation was assessed during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). A Deficiency was cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report along with the appeal rights (LIC 9058) were provided to Administrator Daniel Yoo