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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603790
Report Date: 03/17/2025
Date Signed: 03/17/2025 12:15:10 PM

Document Has Been Signed on 03/17/2025 12:15 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: 12DATE:
03/17/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:57 AM
MET WITH:Kim, Hyo Sook, A LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:18 PM
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Licensing Program Analyst (LPA)) Alberto Lopez conducted an announced subsequent pre-licensed visit to verify corrections and met with Hyo Sook Kim, Licensee and Okkyung (Julie) Coreas, Administrator for the purpose of inspecting corrections.

The following were inspected and corrected

· Side of garage and back of the home needs to be cleared of debris - corrected.
· Documents for personnel records need to be available (LIC500) -corrected.
- Mattress pads for all beds.- corrected.
- Sample Menus for one calendar month. - corrected.
- Visiting Policy Posted. - corrected.
- Facility needs new shower chair - corrected.
- All trash bins must have lids - corrected.
- Room #4 needs a lock on the bathroom door and hot water in the faucets. - corrected.
- Room 9 needs tub clutter removed. - corrected.
- Food for 2-day perishable and 7 days non-perishable and perishable - corrected.
- Facility needs to fix fence or replace fence - corrected.
- Bedroom 8 needs new dresser. - corrected.
- Needs activity calendar - corrected.
- Disaster and Mass casualty plan - corrected

The following needs correction:

· Blinds in the front room need repair or replacement. - Front room has broken blind on window and


· Blinds or blackout curtains in rooms and in the living room. - 2 living room windows need black out curtains or blind
- All faucets must have cold and hot water within department regulations. - needs corrections.

Facility Administrator will advise LPA of corrections to schedule subsequent visit if required. Exit interview and copy of report provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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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