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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603330
Report Date: 07/20/2023
Date Signed: 07/20/2023 07:51:01 PM


Document Has Been Signed on 07/20/2023 07:51 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:GARDEN SILVER TOWNFACILITY NUMBER:
198603330
ADMINISTRATOR:KIM, STEVEFACILITY TYPE:
740
ADDRESS:2830 FRANCIS AVETELEPHONE:
(213) 384-7305
CITY:LOS ANGELESSTATE: CAZIP CODE:
90005
CAPACITY:72CENSUS: 67DATE:
07/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Administrator Steve Kim TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Jose Villalobos, conducted a required annual inspection using the Inspection Tool. LPA met with Manager Jiyoung Kim and the purpose of the visit was discussed. Administrator Steve Kim arrived shortly after

Structure/Physical Plant: The facility is a two story building located in a residential area and contains the following: 39 Bedrooms and 42 Bathrooms, dining room, living room, TV room, and activity room, locked storage cabinet for medications and sharps; bathrooms with shower, toilet and washbasin. A center courtyard with shaded area and seating for resident use. The residence is equipped with air conditioning in each room. Accommodations: Adequate accommodations observed throughout facility. Hallway and Doorways: Free and clean of obstruction and debris. Resident Rooms: All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. Bathrooms: All bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats.Linens & Hygiene Supplies: Required linen/supplies observed. Emergency Phone Numbers, Exit Plan & Menu: Facility has a working phone landline. There are phones for residents use. Fire Extinguishers observed charged and up to date Food Service: All food and adequate utensils such as, dishes, cups, bowls and plates are stored at the other location until residents move in. Knives, cutlery and other sharps inaccessible to residents. Smoke Detectors & Fire Extinguishers: Detectors Electrical & connected to central panel recently inspected. Toxins: Locked/stored for staff use only. Hot Water Temperature: Measured between 110 -120 degrees all around the facility. Medications, First-Aid Kit & Book: Medications centrally stored and inaccessible to residents. First aid kit observed. Postings: Required wall postings observed.Residents & Staff Files: LPA reviewed (6) Resident medication records and files , as well as (5) Staff Files .


Inspection tool was completed and no deficiencies were observed. Exit interview was conducted, and a Facility Evaluation Report was provided.

SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023
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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