Facility Evaluation Report

At 7:58am, on 10/16/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection along with the facilities assigned Quality Assurance Specialist from Tri-Counties Regional Center. LPA met with Administrator Junsik Kim, announced who he was and the reason for the visit.

Administrator and LPA conducted a full tour of the facility. This facility has four single occupancy client bedrooms, one full shared/public bathrooms. There is a living room, dining space, a kitchen and office area. The primary bedroom is for live-in staff and it has an on-suite full bathroom. Access to the laundry room and garage is through a locked door for client safety. LPA noted that the backyard has seating and shade for clients and visitors. LPA noted fresh fruit and snacks in the kitchen for clients to enjoy freely. The facility has wired and battery operated smoke detectors in each room that are all working, the carbon monoxide detector is near the kitchen and functioning normally. LPA observed a fire extinguisher near the laundry room door that was tagged current and in the green compression range, serviced on 10/23/2024. LPA tested facility hot water at 109*(f), within regulation temperatures 105*-120* (f). 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. Medications are locked in a cabinet in the kitchen area. Staff and client files are locked in the office 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 Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time.

Exit interview conducted, report signed, and report provided to the Administrator.