Routine inspection·August 25, 2025

On 8/25/2025, Licensing Program Analyst, Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their annual inspection visit. LPA met initially met with staff on duty and explained the purpose of the visit. The Licensee/Administrator Youngsuk Cho (S1) was notified and arrived shortly after. Overview : Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents. Per fire clearance, all residents may be non-ambulatory. Facility has a hospice waiver for 2 residents. Initial Observation: Upon arrival LPA was greeted by staff on duty (S2). Present during this visit were 3 residents in care, with one staff on duty. 1 resident was in the living room area, 1 resident was observed sitting at the dining table doing activity and 1 resident was in their bedroom. LPA observed required posters and facility license at the entrance. Room temperature was at 74 degrees Fahrenheit upon arrival. Physical Inspection : Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clean and in good repair at this time. LPA inspected 4 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout. 1 resident bedroom is currently vacant. LPA measured the hot water temperature in the 1 of 2 bathrooms to be at 117 degrees Fahrenheit. Both resident bathrooms were observed to be in clean and good repair at this time. Fire extinguisher was observed in the kitchen/dining area and was last inspected on 7/17/2025. Smoke and carbon monoxide detectors were observed throughout. {LIC809-1} In the kitchen area, LPA observed sufficient seven day non-perishable and two day perishable food supplies. Pantry was observed to be fully stocked with non-perishable food items. Proper storage of food items were observed. Kitchen refrigerator and freezer were maintained at regulatory temperature. LPA observed medications and lancet to be stored in a kitchen drawer that did not have a lock. Insulin medications and injections were observed in the kitchen refrigerator, not locked. Another medication, Mucinex, was observed in another drawer. Per S1, that belongs to a staff and immediately removed the medication and placed it in the staff room. Inside the kitchen dishwasher, LPA observed a knife and scissors and were not locked. Outdoor area was inspected. LPA observed outdoor furniture for resident use. Emergency walkways were observed to be unobstructed. Fence and gate were in good condition. LPA provided advisory to place a ramp by the exit door to the patio. Per S1, she removed the existing ramp for her other facility, since current residents can ambulate. Per review of 3 of 3 resident’s LIC602A, all residents are non-ambulatory. S1 further stated that she will purchase one for this facility. Advisory was also provided for S1 to ensure garage is not accessible to residents if they choose to store chemicals and other dangerous items in the garage. Record Reviews: Review of 3 of 3 resident files (R1, R2, R3) was conducted, include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Advisory was provided to ensure residents with restricted health conditions have their restricted health care plan. Advisory was also provided to Licensee to ensure each resident have PRN Authorization Letter signed by their physician. Medication review of 1 residents, include review of physician orders for over-the-counter medications. Review of 3 staff files (S2, S3, S4) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. No issues were noted at this time. LPA also reviewed fire drill/disaster drill records; facility conducts quarterly drill. Emergency Procedure Plan was reviewed. Advisory was provided to ensure Administrator will review the plan at least annually or as needed. {LIC809-2} Interviews: LPA interviewed 1 staff and attempted to interview one resident but LPA is unable to understand resident’s language. LPA requested a copy of current Liability Insurance Certificate, LIC500 and LIC308 to be emailed to LPA at arvin.villanueva@dss.ca.gov. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were cited. Exit interview was conducted with S1 to discuss plan of correction and appeals. A copy of the report and appeal rights were provided upon exit. {LIC809-3}