Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 06/27/2023 at 8:34am. LPA was met by Licensee Jung Kim and explained the purpose of the visit. Facility is licensed to serve residents over 60 years old. The facility cares for elderly residents with dementia and is allowed to care for two (2) hospice residents.

LPA OBSERVATIONS: Tour began at 9:15am and was led by licensee. The facility is a single-story building located in a residential area with four (4) client bedrooms, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage. Staff living corridors is currently not occupied.

· Front Yard: Was clean and well maintained. No hazards were observed.

· Kitchen: LPA Ramirez observed kitchen cabinets near stove to contain caked-yellowish and brown splatter stain. LPA Ramirez observed the ceiling above the stove area to contain red and yellow splatter. LPA Ramirez did not observe sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in bottom kitchen cabinet, to be inaccessible to four (4) out of four (4) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to four (4) out of four (4) residents in care. Kitchen sink water temperature was measured at 113.8 degrees F.

· Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed plenty of seating and lighting. LPA Ramirez observed fully charged fire extinguisher in this area.