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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603790
Report Date: 01/27/2025
Date Signed: 02/05/2025 03:42:23 PM

Document Has Been Signed on 02/05/2025 03:42 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ALHAMBRA VILLAFACILITY NUMBER:
198603790
ADMINISTRATOR/
DIRECTOR:		KIM, HYO SOOKFACILITY TYPE:
740
ADDRESS:528 HOWARD STREETTELEPHONE:
(213) 820-3244
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY: 14CENSUS: 11DATE:
01/27/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:01 PM
MET WITH:Kim, Hyo Sook, Administrator TIME VISIT/
INSPECTION COMPLETED:
04:48 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Alberto Lopez and Nicol Wesley conducted an announced pre-licensed visit and met with Hyo Sook Kim, Administrator and Okkyung (Julie) Coreas, for the purpose of conducting a Pre-Licensing Inspection / Component III visit. This Pre-Licensing Inspection is due initial application. The facility has an approved fire clearance for 11 non ambulatory residents, and three (3) bedridden residents. The facility is a single-story home: 9 bedrooms, and 7 bathrooms, dining/ living room, backyard with detached garage used for laundry and storage, located in Alhambra, CA

The physical plant was toured inside and out alongside Hyo Sook Kim, Administrator and Okkyung (Julie) Coreas,. Pre-Licensed Inspection Tool was used.
The following was observed/inspected.

· There are 7 bedrooms that currently occupied and are equipped with one bed, night stand, chair, sufficient lighting, appropriate closet, drawer space and have the required bedding/linen. Remaining 1 bedroom are missing mattress in good repair and all beds are missing mattress pads.


· Bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture.
Sufficient supply of linens available to permit weekly changing are available.
· Sufficient personal hygiene supplies available.
· Laundry machine (wash/dryer) observed.
· 4 bathrooms have working toilets/wash basin, and shower. One tub/shower needs to be cleared of boxes and equipment. One shower has no water.

(continued on 809C)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ALHAMBRA VILLA
FACILITY NUMBER: 198603790
VISIT DATE: 01/27/2025
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(continued from 809)
· Smoke Detectors and Carbon monoxide detectors are interconnected approved in the Fire Clearance.
· Four (4) Fire extinguishers observed and charged.
· Cleaning solutions and sharps need to be locked and stored separately.
· Kitchen cabinets, refrigerator/freezer, oven, microwave, dishwasher are in working condition, clean and sanitary.

The following was observed/inspected:

· Sufficient dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair.


· Sufficient dining space is available for 12.
· Client and Staff files will be stored and locked in a designated file cabinet.
· Physical plant is in good repair.
· Building and grounds are well kept, debris from side entrance needs to be cleared out
· Window screens are in good condition.
· There is a shaded area provided in the backyard to accommodate clients, no bodies of water observed.
· Hot water temperature measured between 104.1 – 108 and is not within Title 22 regulation.
· The residence is equipped with central air and heating, temperature remains at comfortable temp.
· Facility has telephone and internet line operable; Facility phone number is 626-656-4222
· Licensee reports no guns or weapons in the home.

Component III was also completed at the time of the visit and all required documents for Licensing were discussed. Facility did not meet the physical plant/inspection requirements as required per California Code of Regulations Title 22 Division 6.

The following Corrections need to be made prior to clearing the facility for License.

· Blinds in the front room need repair or replacement.


· Side of garage and back of the home needs to be cleared of debris
· Blinds or blackout curtains in rooms and in the living room.
· Documents for personnel records need to be available (LIC500)
(Continue on 809C)
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ALHAMBRA VILLA
FACILITY NUMBER: 198603790
VISIT DATE: 01/27/2025
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- Mattress pads for all beds.
- Sample Menus for one calendar month.
- Visiting Policy Posted.
- Facility needs new shower chair
- All trash bins must have lids
- Room #4 needs a lock on the bathroom door and hot water in the faucets.
- Room 9 needs tub clutter removed.
- Food for 2-day perishable and 7 days non-perishable and perishable
- Facility needs to fix fence or replace fence
- Bedroom 8 needs new dresser.
- Needs activity calendar
- Disaster and Mass casualty plan
- All faucets must have cold and hot water within department regulations.

Licensee will contact LPA when all corrections are in place to schedule subsequent visit.

An exit interview was conducted, and a copy of this report has been furnished to Hyo Sook (Monica) Kim, Administrator and Okkyung (Julie) Coreas. Accordingly.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC809 (FAS) - (06/04)
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