Pre-licensing visit·April 3, 2025

Licensing Program Analyst (LPA) Michael Tea made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA Tea met with designated Administrator (AD) Tae Sun Kim. An application to operate a Residential Care Facility for Elderly (RCFE) was received by our agency on January 14, 2025 for a total capacity of six ambulatory only. Fire clearance was approved by a fire inspector from the Orange County Fire Authority on February 10, 2025. The facility is a one-story home with three resident bedrooms that are shared rooms, one staff room, two and half bathrooms, a living room, a kitchen, a dining area, and an attached two car garage. There are two backyard exit gates on each side of the house that are self-latching and unlocked. There is a seating area but no umbrella for residents in the backyard. LPA observed big glass tabletops that were in the backyard that needs to be disposed of for the safety of residents. LPA did not observe any administrator certificates on the wall. The See Something, Say Something poster (PUB 475) was small and did not meet the department standards. There was no Ombudsman poster posted as well. LPA did observe Personal Rights, Facility sketch and Emergency Disaster Plan in the facility mounted on the wall of the facility entryway. Fire extinguishers are located at the front entryway by the living room and garage entryway fully charged. Fire alarms and carbon monoxide detectors worked properly and are operational. Resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to residents and will be stored and locked in Pre-licensing Inspection continued on LIC809-C the cabinets in the laundry area. Medications will be stored in a locked cabinet in the kitchen. The first aid kit is also stored in the locked cabinet in the kitchen. The first aid kit is incomplete, the kit is missing a thermometer and a pair of tweezers. Staff and resident records will also be stored and locked in the kitchen cabinet. LPA observed activities like calligraphy and wood craving provided by the administrator in the the living room. There is no phone for the residents. There is a laptop for residents to use in the staff office area. A supply of perishable and non-perishable food was observed and will be maintained on hand. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. Sharps are stored in box container secured in a lock cabinet in the kitchen. Hot water temperatures in the bathrooms measured around 107.2 Fahrenheit degrees. Emergency food and water and additional supplies were observed to be well stocked in the staff area and garage. Licensee will need to address the following issues and need to be corrected to be licensed: · Umbrella for shade in the patio area · Administrator certificate · Pub 475 “See Something Say Something” Poster needs to be 20x26 · Ombudsman Poster · First Aid kit is missing: thermometer and pair of tweezers · First Aid booklet · Backyard needs to be clear of hazards such as glass tabletops · Window and door alarms or alerts. · Telephone for residents to use The facility is not ready to be licensed. Licensee will contact the LPA to schedule a second Pre-licensing visit when corrections are completed. An exit interview was conducted, and a copy of this report was provided to Licensee.