Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced to conduct a Required-1 Year Annual Inspection and met with staff, Julie Smith. Administrators, Jina Kim, and David Kim, who both arrived shortly to the facility. LPA observed all residents to be resting in their rooms at the start of the inspection. The facility has an approved hospice waiver for (4) residents. Currently, there is (1) hospice resident. The second floor is used by staff and residents do not access.

LPA and Administrator toured the interior/exterior of the first floor of the facility including the common areas, (4) private resident rooms, (1) shared resident room, (2) resident bathrooms, kitchen, laundry room and garage. LPA observed the facility to be clean, in good repair and odor-free. There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps, toxins and medications are locked in the kitchen. There is a locked box for medications in the refrigerator. Hot water measured 105*F in a resident bathroom. Fire extinguisher was last serviced June 29, 2026 and smoke/monoxide alarms are working. Inside temperature measured 79*F. Required postings are visible.

LPA reviewed (2) resident files and (2) staff files. Files are complete with all required documentation. Medications were reviewed for (2) residents. There are current orders, documentation and medications are being administered per orders. Staff has completed current training, including First Aid/CPR, and is associated/cleared. Administrators have current RCFE Administrator certificates on file. #7035397740 (exp 6/21/27) and #7035398740 (7/5/27). LPA obtained an updated copy of LIC308, insurance, and LIC500.

There were no deficiencies observed during today's inspection.