Facility Evaluation Report

On 4/23/2025 at 10:30 AM, Licensing Program Analyst (LPA) Eldin Serrano conducted an announced visit to confirm that all of the residents have been relocated in anticipation for the facility's closure. LPA Serrano were granted entrance by the licensee Jumsoo Kim.

On 4/03/2025, LPA Serrano was informed that there are no more residents living in the facility. The licensee is initiating this closure. LPA inspected the entire facility which included the bedrooms, bathrooms, dining area, kitchen, and the backyard. There were no residents present, and there were no belongings of residents in the facility. Licensee Jumsoo Kim stated that the reason of the closure is due to licensee’s retirement after 20 years.

Licensee Jumsoo Kim submitted the following during the closure plan.

1. Letter to Community Care Licensing Division (CCLD).

2. Names of the three (3) residents (resident roster) and where they were relocated.

Jumsoo Kim will surrender the original license to LPA Serrano via mail or deliver to the regional office.

The effective date of closure will be 4/30/2025.

An exit interview was conducted, where this report, LIC809 was discussed with and provided to Jumsoo Kim .