Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced Plan of Correction (POC) inspection visit to verify correction of deficiencies cited during the facility's Annual Required Inspection conducted on 05/01/2026. LPA was greeted by and granted entry into the facility by Licensee/Administrator (LE/AD) Tae Sun Kim. LPA explained the purpose of the visit.

During today's inspection, LPA toured the facility with the administrator to verify that the cited deficiencies had been corrected. LPA reviewed and verified required documentation, including the submission of a death report for a resident who was receiving hospice services and passed away. LPA confirmed that the facility maintains current liability insurance coverage. Water temperature was tested and measured at 115.0°F, which is within department standards. LPA verified that all pathways throughout the facility were free of obstructions and that resident and staff rosters had been completed and updated. Resident and staff files were reviewed and found to be complete and organized. LPA also verified that required annual staff training had been completed. LPA confirmed that the facility maintained an adequate supply of emergency food and water and verified that the most recent quarterly emergency disaster drill was conducted on 04/21/2026.

Based on observations and records reviewed during today's inspection, LPA determined that the facility has corrected all cited deficiencies and fulfilled the Plan of Correction requirements by the assigned due date of 06/01/2026. Therefore, the following Type B deficiencies are cleared: CCR Sections 87211(a)(1), 87303(e)(2), 87307(d)(6), 87412(f), 87413(a)(1), and 87506(a); and Health and Safety Code Sections 1569.605, 1569.625(b)(2), 1569.695(a)(2), 1569.695(c), and 1569.695(e)(1).

An exit interview was conducted with Administrator Tae Sun Kim, and a copy of this report was provided to the facility.