Facility Evaluation Report
Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA were met by Hyo Seon Kwak, Caregiver and explained the purpose of the visit. Shortly after, Administrator Eunice Kim arrived and assisted LPA with the inspection. The facility is approved to serve elderly residents, age 60 and over, (4) ambulatory and (2) non-ambulatory, non ambulatory in room #1 only. Hospice waiver approved for (6) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:
Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Bathroom has hygiene items such as hand soap and toilet paper.
Operational Requirements: Fire Drill is conducted monthly and the last drill was conducted in July 2025. Facility has working signal systems in exit points. Facility maintains liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate and expires on 10/21/2026.
Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (4) resident bedrooms, (2) bathrooms, living room, dining room, kitchen, and attached garage. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. LPA observed cameras in the common areas with no audio. The fireplace is adequately screened with a lock. Backyard was inspected and has a shaded area and sitting area.There is a swimming pool in the backyard and is secured by a fence. There is (1) fire extinguisher in the facility which was purchased o n 09/08/2025. Smoke alarms and carbon monoxide were tested and operable. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. Hot water readings were 111.0 deg F in bathroom #1 and 108.2 deg F in bathroom #2. ****REPORT CONTINUED ON LIC809-C*****
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction