198603330-12-7-2022-28-AS-RORN-CM4LKF-20221214074926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603330
Report Date: 12/07/2022
Date Signed: 12/07/2022 03:58:09 PM

Unsubstantiated

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
10/25/2022 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221025164239

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: 46	DATE:	12/07/2022
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Manager Jiyoung Kim Manager		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is in disrepair
Staff are not provided their prescriptions as prescribed
Staff do not adequately supervise residents to prevent falls

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

The purpose of this report is to correct the regulation cited. LPA indvertently cited under wrong regulation #.
Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Manager Jiyoung Kim Manager and explained the reason for the visit.
The purpose of the visit is to investigate the above allegations.
At today's visit at 10:30 AM tour of the facility was conducted which included resident rooms 103, 107, 108, 110, 203, 204, 205, and 209, resident restrooms, dining room, television room, library, kitchen area, activity room and elevator.
Interview was conducted with Resident's R 1- R 5 from 11:00 AM to 11:45 AM.
Interview was conducted telephonically with Administrator Steve Kim at 9:50 AM.
Interview was conducted with Manager Jiyoung Kim Manager at 11:45 AM.
Resident and Staff Roster were submitted.
In regards to the allegation Facility is in disrepair, LPA toured the facility and observed the facility in good repair. Client rooms inspected had the necessary furniture and beddings and hot water temperature measured between 105F. and 120 F. The elevator was operable and all utilities were operable.

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: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 28-AS-20221025164239

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: 12/07/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Resident's R1-R5 all stated that the facility was in good repair and their room had nothing broken or in need of repair.
Staff interviewed stated that any minor repairs are handled right away by maintenance and that facility has been in good repair with no major issues.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
In regards to the allegation Staff are not provided their prescriptions as prescribed, based on interviews conducted, review of medication and information gathered all residents interviewed stated that they get all their medication daily and have not missed any doses.
Staff interviewed stated that all residents get their prescribed medication and have not missed any doses.
Review of medication was done for Resident's R1-R5 at today's visit and all medication was given as prescribed with no doses being missed.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
In regards to the allegation Staff do not adequately supervise residents to prevent falls, based on interviews conducted and information gathered Resident's R1-R5 stated that they have not fallen and not observed anyone falling. Stated that staff do a good job supervising and that there are enough staff.
Staff interviewed stated that there are 5 to 7 staff on shift from 6:30 AM to 7:30 PM and that staff check every 2 hours on residents in rooms and will always be watching residents and supervising.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
10/25/2022 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221025164239

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: 46	DATE:	12/07/2022
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Manager Jiyoung Kim Manager		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility front door is kept locked preventing residents from entering or exiting

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

In regards to the allegation Facility front door is kept locked preventing residents from entering or exiting, based on observation, interviews conducted and information gathered, LPA upon arriving at the facility at 9:30AM had to ring the bell for entry with door being locked.
Staff interviewed stated that front door is open from the inside, but is locked on the outside coming back into the facility.
Resident's R1-R5 all stated that the front door is always locked.

Based on LPA's observations and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.
California Code of Regulations, Title 22, Division 6, Chapter 1, are being cited on the attached LIC9099-D.

Substantiated

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: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20221025164239

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/03/2022 Section Cited CCR 87468.1(a)(6)	1 2 3 4 5 6 7	Personal Rights Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator will ensure that residents have the right to leave the facility at any time and not have doors locked when regaining entry. Administrator will submit a plan of action that will ensure that residents are not locked out from reentry and at the same time ensure their safety,
	8 9 10 11 12 13 14	Based on interviews conducted and observation licensee failed to enable residents to leave or depart the facility at any time with having the outside door locked when coming back into the facility which causes an Immediate Health and Safety Risk to residents in Care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4