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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606175
Report Date: 05/23/2025
Date Signed: 05/23/2025 04:22:02 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/23/2025 04:22 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:MUGUNGHWA SILVERTOWNFACILITY NUMBER:
197606175
ADMINISTRATOR/
DIRECTOR:		ESTHER HONGFACILITY TYPE:
740
ADDRESS:1423 S. MANHATTAN PLACETELEPHONE:
(323) 373-1980
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY: 56CENSUS: 38DATE:
05/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Eugene Choi, licenseeTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection on 5/23/25. LPA met with licensee, Eugene Choi, and explained the purpose of the visit. The administrator, Jessica Watanabe, also assisted with the visit. The facility is licensed for 56 residents, of which 24 may be non-ambulatory. The non-ambulatory residents are approved for the 1st floor only.

The facility is a two-story building. The first floor consists of the administrator’s office, resident bedrooms, dining area, kitchen, activity room, laundry room, and medication room. There is a covered outdoor area. The second floor consists of resident bedrooms and an activity room. There is one elevator on the premises. The smoke detectors are interconnected and linked to the fire department. Food supplies are sufficient and are purchased at least 4 times a week. There are no items obstructing the walkways. The facility appears clean and free of odor. The hot water temperature was measured within 105-120 degrees F. The facility could not provide proof of the liability insurance covering injuries in the amount of at least $1,000,000 per occurrence and $3,000,000 in total annual aggregate. LPA reviewed 5 resident files and their medications. The files have the required documents. Medications are centrally stored in the med room. LPA observed that the evening medications for Resident #1 were not given for approximately 8 days and Resident #3 was not given the Mirtazapine medication daily. LPA reviewed 4 staff files. The administrator’s (Hyun Joo Watanabe) certificate expires on 11/18/25. Staff #2 did not have a completed health screening on file. The administrator confirmed that staff did not receive training during the 2024 year. LPA provided a technical violation for not having emergency drills conducted at least quarterly for each shift.

The deficiencies are issued on the LIC809D. An exit interview was held with the administrator. A copy of this report, along with appeal rights, was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/23/2025 04:22 PM - It Cannot Be Edited


Created By: Cynthia D Chan On 05/23/2025 at 03:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MUGUNGHWA SILVERTOWN
FACILITY NUMBER: 197606175

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/06/2025
Section Cited
CCR
87411(f)

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87411 Personnel Requirements - General
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician.
This requirement is not met as evidenced by:
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The licensee shall ensure all employees have a health screening performed by a physician on file and ensure that Staff #2 obtains a health screening by due date 6/6/25.
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Based on record review, the licensee did not comply with the section cited above in which staff #2 did not have a health screening done upon hire which posesd a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Fernando Fierros
NAME OF LICENSING PROGRAM MANAGER:
Cynthia D Chan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 05/23/2025 04:22 PM - It Cannot Be Edited


Created By: Cynthia D Chan On 05/23/2025 at 03:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MUGUNGHWA SILVERTOWN
FACILITY NUMBER: 197606175

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2025
Section Cited
HSC
1569.605

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On and after July 1, 2015, all residential care facilities for the elderly...shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees.
This requirement is not met as evidenced by:
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The licensee shall ensure the liability insurance is maintained for the facility at all times. The proof of insurance with the required amount shall be submitted to LPA by 5/30/25.
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Based on interview, the licensee did not comply with the section cited above in which the liability insurance was not available upon request which poses a potential health, safety or personal rights risk to persons in care.
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Type B
05/30/2025
Section Cited
HSC1569.625(b)(2

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(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.
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The licensee shall ensure that the staff are receiving training during the year to fulfill the requirements. A statement acknowledging this regulation shall be submitted to LPA by 5/30/25.
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Based on record review, the licensee did not comply with the section cited above in staff were not given the annual 20 hours training which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Fernando Fierros
NAME OF LICENSING PROGRAM MANAGER:
Cynthia D Chan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/23/2025 04:22 PM - It Cannot Be Edited


Created By: Cynthia D Chan On 05/23/2025 at 03:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MUGUNGHWA SILVERTOWN
FACILITY NUMBER: 197606175

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2025
Section Cited
CCR
87465(a)(4)

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87465 Incidental Medical and Dental Care
(a) A plan for incidental medical and dental care shall be developed by each facility. (4) The licensee shall assist residents with self-administered medications as needed.
This requirement is not met as evidenced by:
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The licensee shall ensure the medications are being given as prescribed by the physician. An in-service training shall be given to all staff handling medications and submit the log to LPA by 5/24/25.
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Based on observation, the licensee did not comply with the section cited above in 2 of the residents' medications were not given as ordered by the physician which poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Fernando Fierros
NAME OF LICENSING PROGRAM MANAGER:
Cynthia D Chan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2025


LIC809 (FAS) - (06/04)
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