Facility Evaluation Report

On May 8, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Deficiencies visit. The visit is being conducted in conjunction with complaint control number 22-AS-20260506115738 . Administrator (AD) Hyo Kim was present and assisted on today's visit.

During the investigation into complaint control number 22-AS-20260506115738, LPA requested to review the file for Resident #1 (R1). LPA was informed that R1 moved into the facility on May 4, 2026, however, the facility only had a discharge summary report dated May 4, 2026 on file for R1. The AD informed LPA that the facility did not have an admission agreement, medical assessment, or pre-admission appraisal for R1. The AD also informed LPA that R1 moved out of the facility on May 7, 2026.

Based on the information gathered during the visit, a deficiency is being cited on the attached LIC809-D page. An exit interview was conducted with Administrator Hyo Kim. A copy of the report and appeal rights were provided at time of visit.