Facility Evaluation Report

At 10:00am on 09/07/2023, Licensing Program Analyst (LPA) Jeffries arrived for the scheduled appointment time for the pre licensing appointment. LPA met with Licensee Young Won and Administrator Junsik Kim.

At 10:10am Licensee, Administrator and LPA conducted a full review and reading of the pre licensing care tools modules. During the review, all applicable questions were affirmed with compliance by observation and documented review. There were no violations discovered during the control tools module read and review.

At 11:15am, Licensee, Administrator, and LPA conducted a physical tour of the facility. LPA observed facility Plan of Operations (PO), Emergency Disaster Plan, Infection control plan and all necessary posting on the facility wall near the entrance and PO was located on facilities computer. This is a 5 bedroom 2 bathroom, living room and open kitchen area. There is ample backyard for clients and visitors to be outside with table and umbrella for shade. Bedrooms 1, 2, 3, and 4 are all single client rooms with proper light, furniture, beds and linins to meet regulation requirements. The 5th bedroom is a staff bedroom with on-suite bathroom. Clients share the single bathroom. Bathroom had paper towels dispenser and is equipped with liquid soap, non-skid stickers on shower floor. Water temperature in the facility was measure at 119*(f). LPA observed smoke detector throughout the facility and carbon monoxide detectors in working condition. LPA observed fire clearance (SD850) dated 08/15/2023 for 4 Ambulatory residents. LPA observe a working fire extinguisher and a complete first aide kit on hand at the facility. LPA observed a generator, emergency food and water supply in the garage. LPA observed chemicals and hazards to be locked and stored in laundry room, closet adjacent to laundry room and under kitchen sink. LPA observed exposed wires from a conduit on the north outside of the facility, Licensee contacted contractor and will report back to LPA by end of business today (09/07/2023) to certify that wires pose no hazard and are not exposed, licensee will also provide photo or this hazard mitigation to LPA. Pending the mitigation plan for the exposed wires, LPA did not find any other violations during the facility tour. LPA will submit report once wire mitigation is confirmed.

Exit interview, report read, and report provided.