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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603687
Report Date: 09/03/2024
Date Signed: 09/03/2024 12:10:41 PM

Document Has Been Signed on 09/03/2024 12:10 PM - 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ART OF LIVING SILVERTOWNFACILITY NUMBER:
198603687
ADMINISTRATOR/
DIRECTOR:
KIM, HYO SOOKFACILITY TYPE:
740
ADDRESS:15431 GARO STREETTELEPHONE:
(213) 820-3244
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY: 6CENSUS: 6DATE:
09/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:staff Eun Kee Byun TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Jose Villalobos conducted a Plan Of Correction Visit (POC) to follow up on deficiencies cited on the Post-Licensing visit conducted on 8/22/24. The purpose of this visit is to follow-up on the POC's that were due on 08/23/24. Upon arriving at the facility, LPA met with staff Eun Kee Byun and explained the purpose of this visit as well as explained to administrator Hyo Kim via phone call.

LPA Villalobos verified the following deficiencies cited on 8/22/24 to be cleared:
  • CCR 87465(h)(5) Facility to return medications to pill bottles contact pharmacy to discharge medications removed from bubble packs by POC due date. LPA observed medications to be in order. Deficiency Cleared.

  • CCR 87355(e)(4) Administrator associated the staff via guardian during the visit. Deficiency was cleared during the initial visit.

  • CCR 87465(h)(2) Administrator placed medications in locked medications cart. Deficiency was cleared during the initial visit

  • CCR 87204(a) Licensee to create and follow plan of relocating residents until they reach the proper capacity they are licensed for by POC due date. LPA to conduct follow up visit to verify. 9/3/24 LPA Villalobos conducted POC Visit and observed facility capacity to be within approved License amount. POC is cleared.

  • CCR 87307(a)(2)(B) Facility to place Resident #8 in an approved bedroom or relocate resident to proper placement by POC due date. LPA Villalobos to conducted follow up visit to verify. 9/3/24 LPA Villalobos conducted POC Visit and observed deficiency to be cleared.


All above citations are cleared at the time of this visit. No further citations provided on this report. Exit Interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2024
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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