Blessed Sacrament Sisters of Charity

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility using the CARE inspection tool. Upon arrival, LPA met with the Administrator Eunmi Kong. The reason for the visit was explained. The facility is licensed to serve six (6) non- ambulatory residents who are 60 years old and over, of which all six (6) are allowed to reside in three (3) rear rooms (shared rooms) on the first floor. The facility has two (2) hospice waivers approved. The facility has two (2) floors. The first floor has a dining room, administrator office, little chapel, activity room, TV room, kitchen, three (3) residents’ bedrooms, one (1) full bathroom, and two (2) half bathrooms. The second floor is for staff use. It consists of three (3) staff bedrooms, three (3) staff bathrooms, one (1) extra/vacant staff room and one (1) storage room. Annual fees are current. The following CARE tool domains were reviewed during this visit: Infection Control: Sufficient PPE supplies and an Infection Control Plan maintained at the facility were observed and in compliance. Physical Plant & Environment Safety: Physical plant tour was conducted. Residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The backyard, outdoor and passageways were free of obstruction and debris/hazards. Storage areas for cleaning solutions, toxins, knives, and hazardous items were kept in a locked cabinet and were inaccessible to residents. (-Continued on the LIC809-C) Water temperature was tested and the temperatures were between 105.8 to 119.1 degrees F., which is in compliance with regulations. Audio devices were working properly. Smoke detectors and carbon monoxide detectors were operable. Fire extinguishers were observed and fully charged. Operational Requirements and Disaster Preparedness: Facility has an activity area furnished for outdoor use. Fire drills were conducted quarterly. The last fire drill was on 7/15/26. Staffing and Personnel Records- Training: There appears to be sufficient staffing at all times in the facility. Staff files were reviewed and in compliance. Administrator certificate is current with the expiration date on 11/10/27. Resident Rights-Information and resident Records-Incident Reports: Facility provided telephone landline and internet for the residents. Resident rights posters and reporting posters were displayed within the facility. Food Service: The kitchen was observed to be clean. Two (2) days of perishables and one-week (7) days of non-perishables food supply were observed. Health Related Service: Medication was properly labeled, centrally stored, and in their original containers. Incidental Medical & Dental and Emergency Intervention: Staff designated to administer medication have the proper training on file. Residents at this facility do not need the use of restraints or de-escalation techniques, however, staff maintain a CPI Certificate in the case of use. Exit: No deficiencies were noted during this visit per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Administrator Eunmi Kong. Copies of LIC 809s were provided.the state’s words, verbatim · CDSS document, Jul 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Annual Required visit to the above facility. LPA was met by Eunmi Kong, Administrator and the purpose of today’s visit was explained. The facility is licensed to serve (6) non-ambulatory residents ages 60 and above and hospice waiver for (2). There are currently (0) residents on hospice. There are currently (4) residents in the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted an a current Infection Control Plan. 2. Operational Requirement: Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 2) PHYSICAL PLANT The facility consists of 4 resident bedrooms, 4 bathrooms (1 bathroom is for visitor use), kitchen, family hall with a prayer room and recreation area, dining room, laundry room located inside the kitchen area. Adequate linen and personal hygiene supplies were observed. Medications were centrally stored, locked and inaccessible to residents in care. Auditory device alarms are operational. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged. The outdoor area has a shaped area and seating. Water temperature was tested between 119.1 – 129.3 degrees F which is not within the required range of 105.0 -120.0 degrees F. (continued on 9099C) (continued from 809) 4. Staffing: The facility has sufficient staff, and the night supervision staff have current CPR/first aid certification. 5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. All staff have required ongoing training. Administrator Eunmi Kong Certificate expires 11/10/2025 6. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Pre-admission appraisal/Appraisal Needs & Services Plan. 7. Resident Rights-Information: The Complaint, ombudsman and CCLD poster are posted at facility. Visiting hours are included in the admission agreement. 8. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. Food Service: The kitchen was inspected and did have sufficient supply of 2-day perishable & 7-day non-perishable food. The kitchen, food preparation area, and storage areas were observed to be very clean and sanitary. Pesticides and cleaning supplies are kept away from the food preparation areas. The kitchen is kept clean and free from rodents. 10. Incidental Medical and Dental: Medication is centrally stored and locked in the medication cabinet near the kitchen. Four (4) centrally stored resident medications were reviewed, which contained 30-day supply of medications. All medications are administered according to physician’s orders. Two (2) residents PRN medications did not have labels. Disaster preparedness: The last fire drill was conducted on 06/16/2025. The facility has an Emergency Disaster Plan posted at the facility. 12. Resident with Special Health Needs: No residents receive home health services. No residents are currently on postural support. Individual Service Plans and Appraisals are on file. Deficiency observed during today’s visit. Technical advisory issued. An exit interview was held. A copy of this report, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 21, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Eunmi Kong and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory elderly residents age 59 and over. Approved Hospice Waiver for 2. The facility is in a residential area and consist of a two-story home and consist of (4) resident bedrooms,(3) bathrooms (1) visitor's bathroom, kitchen, activity area, family hall with a prayer room, foyer, and office, dining room, laundry room located inside the kitchen area, front porch, and a backyard. Second floor is inaccessible to the residents. LPA Flores conducted a tour with Eunmi Kong and observed the following: Facility is in good repair indoor and outdoor. Each common area is clean with furniture in good repair. Each resident bedroom has the required furniture, bedding supplies, and sufficient lighting. Bathrooms are in good repair and water temperature was tested at 111.5 degrees F. Kitchen was observed clean with sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables. Sharps were observed lock in a drawer. Cleaning supplies are inaccessible to the residents. Carbon Monoxide/Smoke detectors were observed throughout the facility in working condition. No large bodies of water were observed. Ramps and passage ways are clear. Backyard has a covered/shaded seating area. LPA reviewed 3 resident files and medication and 3 staff files. Staff has been provided 20 hours of yearly training. However, training on postural support, hospice, health services and restricted conditions was not provided to staff. There are no residents on hospice or home health care at this time. Facility does not have a copy of Infection Control Plan at the time of the visit. However, they are following infection control prevention. (CONTINUED ON LIC 809C) Emergency Disaster plan was available for review. However, pages 4 to 9 were not filled out. Last emergency drill was conducted on 5/1/23 per administrator. Administrator certificate was observed for Eunmi Kong #7035628740 exp. date: 11/10/25. Deficiency was noted on LIC 809D and technical violations and assistance were provided. Exit interview was conducted with Eunmi Kong and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 26, 2024

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.