Facility Evaluation Report

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:30 AM. LPA spoke on the phone with Administrator Kyong Suk Lee who informed LPA that the facility currently has no residents. Administrator arrived to the facility at 10:58 AM. Entrance interview was conducted and the reason for the visit was explained.

Beginning at 11:05 AM, the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS : There are four (4) total bedrooms in the facility. Three (3) are single occupancy rooms. Bedrooms #3 & 4 contained direct exits to the outdoors of the facility. Bedroom #1 was observed to be missing a bed and other required furniture. All other resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Direct exits were observed to be missing auditory alarms.

BATHROOMS : There are two (2) bathrooms for resident use. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms and all were properly secured. The water temperature was measured in resident bathrooms to be between 124.8 and 129.0 degrees Fahrenheit which is outside of the range required by regulation.

KITCHEN/GARAGE : The LPA observed the garage to be locked and inaccessible. The garage was observed to contain the facility washer and dryer along with tools, care supplies, and household chemicals. The kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. LPA observed the facility to be missing a sufficient supply of perishable and non-perishable food. LPA observed a wall mounted fire extinguisher that was fully charged and recently serviced on 06/15/2026. Cont. on LIC 809C.