Arc-Us Village II

Type of visit: Required - 1 Year

On 4/22/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an announced 1-year required visit. LPA Flores met with Administrator Daniel Kim. LPA reintroduced herself and was granted entry into the facility. Currently, the facility does not retain any residents in care and no staff are residing on the premises. A tour was conducted alongside Daniel and the following was observed during the visit: The facility is a single-story structure which consists of (4) four resident bedrooms, (3) three bathrooms, living room, laundry room, kitchen, garage, and secured backyard. LPA observed a covered patio that was fully furnished. Indoor and outdoor passageways were free from obstruction. The kitchen area was observed to be organized and free of liter. The facility maintained a (2) two day supply of perishable foods and (7) seven day supply of non-perishable foods. Knives and other sharp items are to be store in a locked closet near the kitchen. Hallways to the non-private bathrooms were equipped with night lights. Bathrooms were observed to be equipped with the required grab bars and slip-resistant materials. Resident bedrooms maintained the required bedding, furniture, and functional lighting. Laundry services are anticipated to be conducted on-site. Laundry machines were observed to be in operating condition. Cleaning supplies and other disinfectants are stored in a locked closet located in a private bathroom. Carbon monoxide and smoke detectors were tested and observed to be operational. A fully charged fire extinguisher was observed mounted on the wall near the dining room exit. Water temperature measure within the required limits. LPA did not observe any bodies of water during the visit. Per Administrator, there are no firearms and/or ammunition on the premises. LPA observed the required postings of the PUB475, Long Term Care Ombudsman Information, License, Administrator Certification, facility sketch, and emergency disaster plan. (0) Zero staff and resident records were reviewed as there are no residents residing or staff not currently employed at the facility. During the visit, LPA did not observe any health and safety concerns. An exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Prelicensing

On 4/21/2025, Licensing Program Analyst (LPA) Janette Romero made an announced visit to the facility to conduct a pre-licensing inspection. In November 2024, an initial application was submitted to the Centralized Applications Bureau (CAB) to operate a Residential Care Facility for the Elderly in the home. LPA met with Applicant, Jiwoo Kim whose administrator’s certificate expires on 4/4/2026. LPA toured the facility's interior and exterior with Applicant Kim. LPA observed the facility is made up of a one-story home with four resident (4) bedrooms, three (3) restrooms, a kitchen, dining room, living room, and attached car garage. Indoor and outdoor passageways are free of obstruction. The facility has operating utilities and there are no bodies of water on the premises. Applicant Kim tested one of the smoke alarms/carbon monoxide detectors and LPA found them to be hardwired and operational. The facility has a central heating and air conditioning system installed with a central panel located in the hallway to control entire house. All resident bedrooms are adequately furnished with a bed, chair, drawer/closet space and functional lighting. All bathrooms have a working toilet, wash basin, toilet paper, paper towels, and soap readily available. Bathrooms have non-skid mats and grab bars in the showers. LPA tested the hot water temperatures in two (2) restrooms, which measured at 114.9, 115.8-degrees Fahrenheit. LPA toured the living and dining room and observed the facility has a sufficient seating for the requested capacity. LPA toured the kitchen and observed the facility has a two-day supply of perishable foods and seven-day supply of non-perishable food items. Knives and sharp instruments will be secured in a kitchen cabinet. Disinfectants, laundry detergents, and cleaning solutions are secured in a locked cabinet under the kitchen sink. Medications will be centrally stored in a locked cabinet near the staff office area. The facility has a confidential storage area designated for staff and resident records. Emergency phone numbers, residents’ personal rights, and Long-Term Care Ombudsman information are visibly posted near the front entrance. LPA reviewed an undated/unsigned Fire Safety Inspection Request (STD. 850) noting the facility received or requested a fire clearance to serve four (4) non-ambulatory and two (2) bedridden elderly residents ages 60 and over. Applicant Kim reported they requested a fire clearance for four (4) bedridden and two (2) ambulatory elderly residents and the STD. 850 LPA reviewed had a clerical error noting an incorrect request. Applicant Kim added they are actively working with the fire department to receive a corrected and signed copy of the fire inspection request. LPA called the fire department to inquire about the facility's current fire clearance status; however, LPA was informed the assigned fire inspector was not available during the phone call and fire department staff was unable to provide clarification. During today's visit, LPA did not observe any issues or concerns, and there are no additional corrections required. Applicant Kim was advised to update Community Care Licensing when they receive a corrected copy of the STD. 850. Departmental records show Applicant Kim completed the COMP III requirement on 2/11/2025. Final approval of licensure will be granted by the CAB analyst. An exit interview was conducted, and a copy of this report was reviewed and provided to Applicant Kim.the state’s words, verbatim · CDSS document, Apr 21, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): Method: Telephone call with CAB COMP II Participants: Ji Woo Daniel Kim On 1/17/2025, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. 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, Jan 17, 2025