198603330-7-20-2021-28-AS-WSHO-C7ANWN-20210928104950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603330
Report Date: 07/20/2021
Date Signed: 07/20/2021 04:28:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2021 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210504131343

FACILITY NAME:	GARDEN SILVER TOWN		FACILITY NUMBER:	198603330
ADMINISTRATOR:	KIM, STEVE		FACILITY TYPE:	740
ADDRESS:	2830 FRANCIS AVE		TELEPHONE:	(213) 384-7305
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90005
CAPACITY:	72	CENSUS: 51	DATE:	07/20/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Steve Kim		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Resident has missed multiple of her medical appointments
Facility is not allowing the residents to leave the facility
Facility is not allowing visitors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint investigation for the allegations listed above.
LPA met with Administrator Steve Kim.
Today’s complaint investigation consisted of the following:
Interview was conducted with Administrator Steve Kim at 10:00 AM.
Resident R1 was interviewed at 10:20 AM.
Staff Jinho Ha was interviewed at 10:30 AM.
R2 was interviewed at 10:45 AM telephonically.
R3 was interviewed at 10:55 AM.
Family member of R1 was interviewed telephonically at 11:05 AM.
In regards to the allegation Resident has missed multiple of her medical appointments, based on interviews conducted and information gathered all residents and family member of R 1 stated they were allowed to leave facility and go to medical appointments. R 1 stated his daughter would pick him up and take him on medical

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210504131343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: GARDEN SILVER TOWN	FACILITY NUMBER: 198603330
	VISIT DATE: 07/20/2021

NARRATIVE

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appointments.
R 2 stated that he did leave on doctor's appointment's with his daughters.
Family member of R 1 stated that R 1 needed to see a specialist and she was allowed to get R 1 and leave the facility to go on medical appointments.
All staff interviewed stated that doctor will come here at least 1x a month and all residents can leave freely to go to medical appointments.
It should be noted that LPA observed an e-mail to a residents family member dated 4/13/2021 which states family member can leave the facility freely at any time.
Visitors sign in and out sheet was observed for 4/21-5/21 with numerous entries for visitation and leaving facility.
Although the allegation may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED.

In regards to the allegation Facility is not allowing the residents to leave the facility, based on interviews conducted and information gathered all residents, staff and family member of Resident 1 stated that facility allowed residents to leave the facility and would fill out sign in and out sheet
.LPA observed an e-mail to a residents family member dated 4/13/2021 which states family member can leave the facility freely at any time. Visitors sign in and out sheet was observed for 4/21-5/21 with numerous entries for visitation and leaving facility.
Although the allegation may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED.

In regards to the allegation Facility is not allowing visitors, based on interviews conducted and information gathered all residents, family member of Resident 1 and staff stated that facility was allowing visitors.
Resident 1 stated that his son and daughter would visit and bring food.
Resident 2 stated that his daughter would visit him quite often.
Visitors sign in and out sheet was observed for 4/21-5/21 with numerous entries for visitation and leaving facility.
Although the allegation may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

LIC9099 (FAS) - (06/04)

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