Green Bell Care Home

Type of visit: Required - 1 Year

On 9/28/2026, at 12:30 PM Licensing Program Analysts (LPA) Reza Jamaly arrived unannounced at the facility to conduct the required annual inspection. LPA met Administrator Namjung Cho and explained the purpose of the visit. Facility is cleared for 6 resident non-ambulatory residents, waivers granted for hospice care for 2 residents, current census was 2. Upon arrival, LAP observed 2 residents in the hallway watching TV. Firstly, LPA Jamaly inspected the physical plant including but not limited to the common area, kitchen, dining area, 3 resident's bedrooms (room 3 was unoccupied), resident bathrooms, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Jamaly inspected the kitchen and observed a sufficient supply of at least a seven-day supply of nonperishable food and a two-day supply of perishable food. Sharp knives were secured in a locked kitchen cabinet and inaccessible to residents. LPA inspected 2 residents’ bedrooms and observed bedrooms to be properly furnished with appropriate bedding and lighting. Resident's bathrooms were observed to be cleaned, grab bars and non-slip mats were observed to be secure and in good condition. The hot water temperature measured 114.1 at one of the resident bathroom sinks, which is within the required range of 105°F to 120°F. Facility temperature was checked at living room and observed to be 74-degree F. There are no bodies of water present. Smoke detectors and carbon monoxide detectors were found at the facility. One fire extinguisher, located in the kitchen, was last serviced on 4/27/2026. LPA Jamaly observed the facility to be free of odor, clean and in good repair. Page 2 LPA observed that the facility maintained a public telephone in the living room and that all required licensing posters were properly displayed Cleaning supplies and other toxic substances were observed in laundry room and inaccessible to resident. Medication were observed to be stored in a locked cabinet in the kitchen and inaccessible to residents. LPA Jamaly reviewed 2 of 2 residents' medication and corresponding Medication Administration Records (MARs), which were complete and consistent with physician's orders. The first aid kit was inspected and contained all required supplies. LPA requested resident and staff records for review. LPA reviewed 2 out 2 resident's file and found them to be complete. Two (2) staff files were reviewed and found to be complete. A review of personnel records confirmed that all staff members and other individuals required to undergo caregiver background checks had received criminal record clearances and were properly associated with the facility. The following documents were requested and will be emailed to the LPA by 10/2/2026 no later than 5:00 PM. LIC 308 – Designation of Administrative Responsibility Copy of the Administrator Certificate LIC 610 – Emergency Disaster Plan Proof of Current Liability Insurance LIC 500 – Personnel Report LIC 309 – Administrative Organization Based on today's inspection, the facility was found to be in compliance with applicable Title 22 regulations. An exit interview was conducted with Administrator Namjung Cho , and a copy of the LIC 809 Report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 28, 2026

Type of visit: Required - 1 Year

Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 10/15/25. LPA identified, explained the purpose of the visit, and met with the Licensee/Administrator, Namjung Cho. A brief interviewed followed. Currently there was one resident in care. The facility license was posted: this facility was licensed for a capacity of 6 non-ambulatory and was granted a hospice waiver for 2. LPA noted the Administrator/Licensee, certificate, # 6069747740 expired on 04/21/26. LPA observed that the required facility sketch, and Emergency /Disaster plan, were posted along with Resident Rights and the Ombudsman information and "If You See Something, Say Something," poster. The inspection began in the kitchen. All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. All pantry items had visible expiration dates. LPA provided technical assistance on dating containers in the refrigerator with the date the item was opened or repackaged. LPA inspected the 3 resident bedrooms and 2 staff bedrooms. All resident rooms had the required furniture, furnishings and lighting to be in compliance at this time. LPA noted soap, paper towels and trash cans with lids in the bathrooms. The hot water temperature was measured at 109 degrees Fahrenheit and was in compliance. The fire extinguisher was last inspected on 04/08/25 by River City Fire Equipment Co. was were also in compliance. The exterior of the building was inspected by the LPA. There were no bodies of water present and the yard was completely fenced in. LPA observed that all screens and gutters were in good repair. There were no storage sheds or outbuildings. There was also a covered patio area for residents to enjoy. The LPA observed medications were stored in a large cabinet in the kitchen and inaccessible to residents in care. LPA reviewed storage, dosing, and destruction procedures. A review of the First Aid kit by the LPA found it to be complete and in compliance. A file review was completed by the LPA. The review of the resident’s file was complete and in compliance. A review of the file for the caregiver on duty was conducted, it was in compliance and all members listed on the LIC 500 had their required background clearances. According to the California Code of Regulations, Title 22, there were no deficiencies observed or cited during today's inspection. A copy of this report was provided and an exit interview was conducted with Cho.the state’s words, verbatim · CDSS document, Oct 15, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christina Valerio arrived announced to conduct a pre-licensing inspection. LPA Valerio met with Licensee/Administrator Namjung Cho, and explained the purpose of the visit. The facility is licensed to serve individuals 60 years of age and older. Fire Clearance granted for 6 non-ambulatory, master bedroom approved as staff room only, room behind living room approved as staff room only. The facility LPA Valerio and Administrator toured the facility to ensure compliance with Title 22 regulations. Resident bedrooms were fully furnished, clean, and organized. Resident bathrooms were fully stocked and equipped with a shower chair, hand rails, trash can, hand soap, and paper towels. Common areas were fully furnished. LPA observed where staff files, resident files, and medications will be stored. All cabinets were equipped with locks to ensure sharps, chemicals, and medications were locked and inaccessible to residents in care. The facility was observed to have a pantry with food items, a refrigerator and freezer for perishable and non-perishable food items. The backyard exterior area had an area for outdoor visitation, gardening area, and outdoor activities. No health and safety concerns were observed. Pre-Licensing is complete and this facility has no deficiencies. Component III was completed. No further questions. An exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 17, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): N/A COMP II Participants: Namjung Cho, Admin/Licensee Interview Method: Virtual interview (MS Teams) On 7/1/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jul 1, 2024