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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608203
Report Date: 03/22/2024
Date Signed: 03/22/2024 10:52:23 AM


Document Has Been Signed on 03/22/2024 10:52 AM - 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:ELIM HEALTHCARE, INC.FACILITY NUMBER:
197608203
ADMINISTRATOR:TAMMIE CHAFACILITY TYPE:
740
ADDRESS:1126 S. WESTMORELAND AVENUETELEPHONE:
(213) 736-7777
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY:142CENSUS: 130DATE:
03/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Tammie Cha AdministratorTIME COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA) Christian Gutierrez and Licensing Program Manager (LPM) Tony Vasallo conducted an unannounced case management visit to address the change of ownership that was reported to the department. LPA and LPM were met by Administrator Tammie Cha and explained the reason for today’s visit. LPA and LPM toured the facility with Administrator Cha.

On 3-5-2024 facility attorney contacted the department to inquire about who we had listed as shareholders. The attorney also indicated the shareholders had recently changed and that the new shareholders will summit the application change to the department.

During todays visit LPA and LPM met with new owner Jeong Mee Moon and Assistant Administrator Donghyun Moon to discuss timeframe for change of ownership application. They’re working with a consultant and are hoping to have the application in three weeks. If nothing is done by Friday (3/29/2024) they will be looking for a new consultant. LPA and LPM also discussed questions pertaining to the change of ownership application. There were no observed deficiencies on today’s visit.

An Exited interview was held, and a copy of this report was provided to Owner Jeong Moon and Assistant Administrator Donghyun Moon.

SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Christian GutierrezTELEPHONE: 323-981-3984
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2024
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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