Routine inspection·July 10, 2024

Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced to conduct a Required-1 Year Annual Inspection and met with Julie Smith, caregiver. Jina Kim, Co-Administrator, and David Kim, Administrator, were contacted and arrived at the facility shortly. LPA stated the reason for the inspection. The facility is licensed for (6) residents and has a hospice waiver for (4) residents. Currently, there are (2) residents on hospice. LPA and Administrator toured the interior of the first floor, and the exterior of the facility including the common areas, (4) private resident rooms, (1) shared resident room, (2) resident bathrooms, kitchen, laundry and garage. The second floor is used by staff and has a gate so residents do not access. LPA observed the facility to be clean, in good repair and odor-free and each bathroom has the necessary grab bars, non-skid flooring, paper towels, trash can with lid and 20-second hand-washing poster. There is sufficient 2+day perishable and 7+day non-perishable supply of food, and sharps, toxins and medications are locked in the kitchen. There is sufficient PPE/incontinent supplies and linens/towels/blankets. The inside temperature measured 79*F and hot water measured 106*F in a bathroom. Facility conducts quarterly emergency drills, and the fire extinguisher was last serviced 7/21/23. There is a complete First Aid kit. There is (1) unlocked outside gate and a covered patio dining set. There are no pools/ponds. LPA reviewed (3) of (6) resident files and found them to be complete with all required documentation. Medications were reviewed for (2) residents. Medication is being administered per orders and staff is maintaining complete/current documentation. LPA reviewed (2) staff files and found them to contain current training documentation, including First Aid/CPR certification. Administrators have current First Aid/CPR certifications as well as their RCFE Administrator certificates (valid thru June/July 2025). Discussed Guardian system to manage staff roster. An updated copy of liability insurance was obtained (exp 10/24/24). A Technical Advisory note is issued. Exit interview. Copy of report