Facility Evaluation Report

At 07:45am, on 05/22/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. Personnel from Tri-Counties Regional Center were present during the visit. LPA met with Backup Administrator Junsik Kim, announced who he was and the reason for the visit.

Backup Administrator and LPA conducted a full tour of the facility. On the first floor, this facility has two dual occupancy client bedrooms, a live-in staff bedroom and two full bathrooms (one is on-suite to the live-in staff bedroom and one is for shared/public use). There is a living room, kitchen and dining space. Access to the laundry room and garage are through locked doors for client safety. LPA noted that the backyard and the front yard both have seating and shade for clients to enjoy time outside. LPA noted fresh fruit and snacks in the kitchen for clients to enjoy freely. The facility has battery operated smoke detectors in each room that are all working, the carbon monoxide detector is in the hallway and functioning normally. LPA observed a fire extinguisher near the front door that was tagged current and in the green compression range, serviced on 05/21/2025. LPA observed at least 2 - days of perishable and at least 7 - days of nonperishable foods. LPA noted that the facility is clean and in good repair with no obstructions in hallways, doorways or exits. The second floor contains a private residents with a separate entry on the exterior of the facility, no clients reside or have access to the second floor. Medications are locked in a cabinet in the kitchen area. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review.

LPA and backup Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time.

Exit interview, report signed, and report provided.