American Care Home

Type of visit: Case Management - Licensee Initiated

Licensing Program Analyst (LPA) Galarza conducted an announced Case Management visit. The purpose of the visit was to follow-up on the facility closure request. On July 16, 2026 the department received written notification of facility closure. The purpose of the visit was explained to Licensee Taehyung Kim. The last residents were relocated on October 31, 2025. Licensee was informed that the original license is not transferable. A copy of the original license was surrendered to LPA during the visit. Confirmation of facility closure was provided to Licensee. An exit interview was conducted with Licensee Taehyung Kim. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jul 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Orlando Halili caregiver for the facility, and explained the purpose of the visit. Administrator Tae Kim arrived shortly thereafter. There are one (1) ambulatory and one (1) non-ambulatory residents residing within the home. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) non-ambulatory residents over the age of sixty (60), of whom one (1) may be on hospice. The facility consists of a kitchen, a dining room, a living room, a laundry room, an attached garage, a caregiver room, four (4) resident bedrooms, and two (2) restrooms which had hot water temperature readings of 105.6 Degrees Fahrenheit, 110.4 Degrees Fahrenheit respectively. Facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has multiple fully charged fire extinguishers kept in the facility. Operational Requirements: · Fire clearance was approved by LA County Fire Department for a capacity of six (6) non-ambulatory residents over the age of sixty (60), of whom one (1) may be on hospice. · Care and supervision to meet the clients’ needs was observed. · It was discovered that one (1) resident had passed away approximately a week ago, however death report has not yet been submitted to Community Care Licensing Division (CCLD). Staffing: · Three (3) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Three (3) staff files were reviewed for criminal background clearance and training. · Three (3) staff records reviewed have a health screening with a Tuberculosis clearance, and staff have First Aid/CPR trainings that are active. · Two (2) staff members did not have required annual training on the topics of dementia care, hospice care, postural supports, and restricted health conditions documented within the past year. · The administrator’s certificate expires on 8/21/2025. Resident Rights/Information: · Physician orders were reviewed for two (2) residents. · Medications were also reviewed for two (2) residents. Resident Records/Incident Reports: · Two (2) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was posted in the facility. · The last emergency and disaster drill was conducted on 3/29/2025. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. · One (1) resident on hospice does has full bed rails, however they do not have a physician’s order for the rails. Administrator stated he will obtain the order from hospice. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit is documented on the LIC809D pages. Exit interview held and a copy of the report along with appeal rights will be provided by email.the state’s words, verbatim · CDSS document, Jul 1, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Gloria Halili, caregiver for the facility, and explained the purpose of the visit. Administrator Tae Kim arrived shortly thereafter. There are three (3) non-ambulatory clients residing within the home. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control practices and Personal Protective Equipment (PPEs) were observed. · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) non-ambulatory residents, all of which may be on hospice, and a maximum of one (1) terminally ill client. The facility consists of a kitchen, a dining room, a living room, four (4) resident rooms, a laundry room, a backyard area, and two (2) resident bathrooms of which Restroom #1 (R1) had a hot water temperature reading of 110.4 degrees Fahrenheit, and Restroom #2 in the main hallway of the facility had a hot water temperature reading that immediately reached 122.7 degrees Fahrenheit. The facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has two (2) fully charged fire extinguishers in the facility. ·Water temperature readings for one of the bathrooms in the home did not fall within the required range of 105 - 120 degrees Fahrenheit. Operational Requirements: · The Program Design was reviewed. · Care and supervision to meet the clients’ needs was observed. Pub 475 Poster was not posted within the facility. Staffing: · Three (3) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Three (3) staff files were reviewed for criminal background clearance and training. · All staff records reviewed have health a health screening with a Tuberculosis clearance, and all staff have First Aid/CPR trainings that are active. · The administrator’s certificate expires on 5/21/2025. Resident Rights/Information: · Physician orders were reviewed for three (3) resident files. · Medications were also reviewed for three (3) residents. Resident Records/Incident Reports: · Three (3) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan was publicly posted and found within the facility. · The last emergency and disaster drill was conducted on 5/15/2024. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs: · There are two (2) residents who receive services from home health agencies, and the facility has the agreement with the home health agencies documented and on file. · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit is documented on the LIC809D pages. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 9, 2024