198603687-2-3-2025-28-AS-JVIS-DDJVVR-20250203154646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603687
Report Date: 02/03/2025
Date Signed: 02/03/2025 03:46:51 PM

Document Has Been Signed on 02/03/2025 03:46 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 SILVERTOWN		FACILITY NUMBER:	198603687
ADMINISTRATOR/ DIRECTOR:	KIM, HYO SOOK		FACILITY TYPE:	740
ADDRESS:	15431 GARO STREET		TELEPHONE:	(213) 820-3244
CITY:	HACIENDA HEIGHTS	STATE: CA	ZIP CODE:	91745
CAPACITY: 6		CENSUS: 6	DATE:	02/03/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:45 PM
MET WITH:	Administrator Monica Kim		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

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Licensing Program Analysts (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Administrator Monica Kim and the purpose of the visit was explained. The following 12 (CARE) tool domains were utilized during the inspection:

Infection Control:

Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. An Infection Control Plan was observed

Physical Plant/Environment Safety:

The facility is a single-story home: Total of (9) bedrooms of which #1-#6 is for residents only and #7-#9 are staff rooms and office spaces, (3) bathrooms, dining room, (2) living rooms, backyard with locked detached garage, and a laundry area. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are enclosed ponds in the backyard.
Water temperature readings measured within title 22 regulations.

Operational Requirements:

A current Plan of Operation observed. Dementia Care Plan Observed
A fire clearance for 6 residents of which (6) may be non ambulatory and up to three (3) bedridden
Hospice care waiver approved for up to six (6) residents.
Facility has an active liability insurance. Copy was collected and reviewed

Personnel Records - Staff Training:

Administrator on file is current. Administrator certificate is currently active
Five (5) staff files were reviewed. Required documents observed for files reviewed.

Staffing:

Sufficient staff observed during visit

Continued on LIC 809-C

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 SILVERTOWN	FACILITY NUMBER: 198603687
	VISIT DATE: 02/03/2025

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Resident Records - Incident Reports:

A total of six (6) resident files were reviewed. Required documents observed

Resident Rights - Information

Required postings observed
Facility provides internet services to residents in care

Food Service:

Sanitation practices and kitchen cleanliness was observed.
Kitchen has utensils for clients to use and to store their meals

Planned Activities:

Sufficient space to accommodate both indoor and outdoor activities was observed.
Activities supply observed

Incident Medical and Dental:

Emergency transportation available
First Aid Kid observed
(5) of (6) Resident medications reviewed. (1) Resident has their medication handled by family.

Disaster Preparedness:

Emergency and Disaster Plan observed
Emergency drills conducted per title 22 guidelines

Residents with Special Health Needs:

Needs and Services Plans are on file for all residents.
Currently (2) residents receiving home health services. Written agreement of services observed.
(0) Residents are on hospice.

Inspection Tool was completed and per Title 22 no deficiencies are being cited on todays visit. Exit interview conducted. Copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025

LIC809 (FAS) - (06/04)

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