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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603687
Report Date: 11/27/2023
Date Signed: 11/27/2023 09:32:01 AM

Document Has Been Signed on 11/27/2023 09:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:ART OF LIVING SILVERTOWNFACILITY NUMBER:
198603687
ADMINISTRATOR:KIM, HYO SOOKFACILITY TYPE:
740
ADDRESS:15431 GARO STREETTELEPHONE:
(213) 820-3244
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY: 6CENSUS: 0DATE:
11/27/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Hyo Sook Kim, Administrator
Byunk Hak Yoo, Applicant		TIME COMPLETED:
09:24 AM
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Component II completion: Unsuccessful

Facility Type: Residential Care Facility for Elderly (RCFE)
Application Type: Initial
Capacity: 6
Census (if any clients in care): none
COMP II Participants: Hyo Sook Kim, Administrator
Byunk Hak Yoo, Applicant
Interview Method: Telephone interview
Virtual interview ( Microsoft Teams)

On November 27, 2023, applicant and administrator participated in COMP II. Previous dates 10/23/2023, 11/1/2023, and 11/20/2023. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During the COMP II, applicant and/or administrator did not provide sufficient knowledge of the program and/or community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Component II will be rescheduled to December 15, 2023 at 9:00 AM..

Exit interview conducted with Applicant and Administrator. Report sent via email and informed to return signed back to CAB by end of business day today.
SUPERVISORS NAME: Darla Neeley
LICENSING EVALUATOR NAME: Celia Phomphachanh
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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