Facility Evaluation Report

At 7:55am on 04/03/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced to the facility to conduct the annual facility inspection. LPA met with Administrator Junsik Kim, announced who he is and the reason for the visit.

Administrator and LPA conducted a tour of the facility. This is 5 bedroom, 2 bathroom home with a kitchen, living room and dining space. Each client has their own room and all share one full bathroom. The primary bedroom is a staff room and has an on-suite bathroom for staff. The outside has seating and a terrace for shade. There are working smoke detectors throughout the facility and a working carbon monoxide detector. There is a fire extinguisher in the dining room that is in the green pressure range and serviced on 01/22/2025. Medication is locked and stored in a locked cabinet in the kitchen. First Aid kit is located on the stand in the dining room where the PPE is located. LPA noted that all client bedrooms have all regulated furniture, clean linens, and bedding. LPA tested facility water at 107.6*(f), within regulation temperatures 105*-120* (f). LPA noted the facility was heated to 68*(f). LPA noted that there is at lease 2 days of perishable and at least 7 days of non-perishable foods. LPA noted that the facility is clean and in good repair. LPA noted that all walkways, halls, and doorways are free and clear of debris and obstacles. Staff and client files are locked in the living room. LPA conducted a medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review.

LPA and Administrator conducted a review of the annual care tool modules.

Exit interview, report read, and report provided.