Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA Tea met with designated Administrator (AD) Tae Sun Kim.

An application to operate a Residential Care Facility for Elderly (RCFE) was received by our agency on January 14, 2025 for a total capacity of six ambulatory only. Fire clearance was approved by a fire inspector from the Orange County Fire Authority on February 10, 2025.

The facility is a one-story home with three resident bedrooms that are shared rooms, one staff room, two and half bathrooms, a living room, a kitchen, a dining area, and an attached two car garage. There are two backyard exit gates on each side of the house that are self-latching and unlocked. There is a seating area but no umbrella for residents in the backyard. LPA observed big glass tabletops that were in the backyard that needs to be disposed of for the safety of residents.

LPA did not observe any administrator certificates on the wall. The See Something, Say Something poster (PUB 475) was small and did not meet the department standards. There was no Ombudsman poster posted as well. LPA did observe Personal Rights, Facility sketch and Emergency Disaster Plan in the facility mounted on the wall of the facility entryway. Fire extinguishers are located at the front entryway by the living room and garage entryway fully charged. Fire alarms and carbon monoxide detectors worked properly and are operational.

Resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to residents and will be stored and locked in

Pre-licensing Inspection continued on LIC809-C