Pre-licensing visit·April 21, 2025

On 4/21/2025, Licensing Program Analyst (LPA) Janette Romero made an announced visit to the facility to conduct a pre-licensing inspection. In November 2024, an initial application was submitted to the Centralized Applications Bureau (CAB) to operate a Residential Care Facility for the Elderly in the home. LPA met with Applicant, Jiwoo Kim whose administrator’s certificate expires on 4/4/2026. LPA toured the facility's interior and exterior with Applicant Kim. LPA observed the facility is made up of a one-story home with four resident (4) bedrooms, three (3) restrooms, a kitchen, dining room, living room, and attached car garage. Indoor and outdoor passageways are free of obstruction. The facility has operating utilities and there are no bodies of water on the premises. Applicant Kim tested one of the smoke alarms/carbon monoxide detectors and LPA found them to be hardwired and operational. The facility has a central heating and air conditioning system installed with a central panel located in the hallway to control entire house. All resident bedrooms are adequately furnished with a bed, chair, drawer/closet space and functional lighting. All bathrooms have a working toilet, wash basin, toilet paper, paper towels, and soap readily available. Bathrooms have non-skid mats and grab bars in the showers. LPA tested the hot water temperatures in two (2) restrooms, which measured at 114.9, 115.8-degrees Fahrenheit. LPA toured the living and dining room and observed the facility has a sufficient seating for the requested capacity. LPA toured the kitchen and observed the facility has a two-day supply of perishable foods and seven-day supply of non-perishable food items. Knives and sharp instruments will be secured in a kitchen cabinet. Disinfectants, laundry detergents, and cleaning solutions are secured in a locked cabinet under the kitchen sink. Medications will be centrally stored in a locked cabinet near the staff office area. The facility has a confidential storage area designated for staff and resident records. Emergency phone numbers, residents’ personal rights, and Long-Term Care Ombudsman information are visibly posted near the front entrance. LPA reviewed an undated/unsigned Fire Safety Inspection Request (STD. 850) noting the facility received or requested a fire clearance to serve four (4) non-ambulatory and two (2) bedridden elderly residents ages 60 and over. Applicant Kim reported they requested a fire clearance for four (4) bedridden and two (2) ambulatory elderly residents and the STD. 850 LPA reviewed had a clerical error noting an incorrect request. Applicant Kim added they are actively working with the fire department to receive a corrected and signed copy of the fire inspection request. LPA called the fire department to inquire about the facility's current fire clearance status; however, LPA was informed the assigned fire inspector was not available during the phone call and fire department staff was unable to provide clarification. During today's visit, LPA did not observe any issues or concerns, and there are no additional corrections required. Applicant Kim was advised to update Community Care Licensing when they receive a corrected copy of the STD. 850. Departmental records show Applicant Kim completed the COMP III requirement on 2/11/2025. Final approval of licensure will be granted by the CAB analyst. An exit interview was conducted, and a copy of this report was reviewed and provided to Applicant Kim.