Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea made an announced inspection visit to follow up on corrections identified during a Pre-Licensing visit on 04/03/2025. LPA Tea was greeted and granted entry by Licensee/Administrator Tae Sun Kim. An initial application to operate a Residential Facility Care for the Elderly was submitted to CCLD on 01/25/2025 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.

At around 8:50 AM LPA toured the facility and observed the following:

· Administrator Certificate with an expiration date of 11/24/2026 posted in the front entry way

· “See Something Say Something” (PUB 475) Poster posted in the front entry way

· Ombudsman Poster posted in front entry way

· First Aid Kit with all the required elements: thermometer, tweezers, bandages, dressing, scissors

· Backyard was clear of hazards and obstructions

· Telephone available for residents to use

Noted items from the prior visit on 04/03/2025 have been addressed. The facility is ready to be licensed. LPA conducted the Component Three Orientation with Licensee/Administrator Tae Sun Kim. Licensee was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted, and a copy of this report was provided to Licensee.