198603774-3-3-2026-28-AS-NGAA-DRU39R-20260303170333

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603774
Report Date: 03/03/2026
Date Signed: 03/03/2026 05:03:54 PM

Document Has Been Signed on 03/03/2026 05:03 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:	ELIM SILVERTOWN		FACILITY NUMBER:	198603774
ADMINISTRATOR/ DIRECTOR:	CHA, TAMMIE		FACILITY TYPE:	740
ADDRESS:	1126 S. WESTMORELAND AVE.		TELEPHONE:	(213) 736-7777
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90006
CAPACITY: 142		CENSUS: 133	DATE:	03/03/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:25 AM
MET WITH:	Tammie Cha, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:10 PM

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	Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. LPA met with med-tech Mylene Cho. Administrator/LVN Tammie Cha arrived later. The Residential Care for Elderly (RCFE) facility serves residents ages 60 and over. There is a Memory Care Unit for cognitively impaired residents. The following were observed/inspected: Infection Control: The facility has an Infection Control Plan. Operational Requirements: The facility has an approved fire clearance for 142 non-ambulatory residents, of which 4 may be bedridden. A hospice waiver for 20 residents is approved. Facility does not handle resident monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 10/24/2026. Physical Plant/Environment Safety: The facility is a 4-story building with 71 resident rooms, a Memory Care unit located on the 2nd floor, laundry rooms in each floor, medication room, kitchen, dining room/activity rooms located in each floor, library, administration offices, outdoor side yard patio area, and basement parking garage. The interior and exterior was inspected. All common areas and 26 rooms were inspected. Resident rooms have required furniture, bedding, linens, and lighting. However, the majority of resident beds do not have mattress pads. The signal system was tested and is operational. There are evacuation chairs on facility stairwells to be used during an emergency as a path of egress from the facility to safety. Cleaning supplies and toxic substances are inaccessible to residents. The facility is equipped with sprinklers, smoke detectors, carbon monoxide detectors, and has fire extinguishers. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. Two knives and two scissors were observed in the Memory Care Unit unlocked refrigerator freezer. Exit doors are free of any obstruction. The last fire inspection was conducted on 2/13/2026 by CV Fire Protection, Inc.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2026

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: ELIM SILVERTOWN	FACILITY NUMBER: 198603774
	VISIT DATE: 03/03/2026

NARRATIVE

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Staffing: A total of 39 staff members provide care and supervision of residents.

Personnel Records/Staff Training: Administrator certificate expires 3/2/2026. Staff have criminal background clearance. Nine (9) staff files were reviewed. They contained 1st Aid/CPR training, criminal background clearance, health/TB screenings, 1st Aid/CPR training, and training records.

Resident Records/Incident Reports: 10 resident files were reviewed. They contained Admission Agreements, Service Plans, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent, and centrally stored medication records. R1, R5, R6 & R7 have have medical assessments that are more than 12 months old.

Planned Activities: Facility activity calendar was posted. Sufficient space to accommodate both indoor and outdoor activities was observed. RCFE & Ombudsman complaint posters are posted.

Food Service: Food supply was checked in the kitchen and pantry storage areas, consisting of 2-day perishables, 7-day non-perishables, and emergency food supplies. Residents have physician orders for modified diets. A diet list was observed in the kitchen. Sanitation practices and kitchen cleanliness was observed. Breakfast meals are cooked on site and lunch and dinner meals are prepared by an outside catering company. Kitchen personnel have current food handling certificates.

Incident Medical and Dental: Centrally stored resident medications were reviewed; containing a 30-day supply of medications. Medical and dental transportation is provided by family or facility van. Vitamins were found unlocked in R2's room without a physician order.

Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed and is updated. Facility has a First Aid Kit and Manual. The last emergency disaster drill was conducted on 2/19/2026.

Residents with Special Health Needs: There are currently 4 residents receiving hospice services, 27 residents receive home health services, and no residents have prohibited health conditions. Individual Service Plans, Appraisals, and postural support physician orders are on file.

Pursuant to Title 22, deficiencies were observed and are cited.

Exit interview was conducted with Tammie Cha. A copy of report and appeal rights were issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/03/2026 05:03 PM - It Cannot Be Edited

Created By: Noemi Galarza On 03/03/2026 at 04:12 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: ELIM SILVERTOWN	FACILITY NUMBER: 198603774
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87303(e)(2)

Maintenance and Operation

(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above because the hot water temperature readings were, room 212: 124.5 DF, room 218: 122.5 DF, room 230: 95.1, room 313: 98.7 DF, which poses an immediate health and safety risk to persons in care.
	POC Due Date: 03/04/2026
	Plan of Correction
1 2 3 4	Administrator shall ensure the hot water temperature in the facility is within 105-degree F (41 degree C) and not more than 120-degree F (49 degree C). Submit by tomorrow a water temperature log showing hot water readings were tested each shift today and tomorrow.

Type A

Section Cited

CCR

87309(a)

Storage Space and Access

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that there were 2 knives & 2 scissors in the unlocked refrigerator freezer of the Memory Care Unit activity room, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/04/2026
	Plan of Correction
1 2 3 4	Staff removed the knives and scissors and stored them in the locked supplies cabinet. Submit by tomorrow proof of staff-in service training in regulation 87309 and 87705.

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

	Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:

	Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2026

LIC809 (FAS) - (06/04)

Page: 4 of 7

Document Has Been Signed on 03/03/2026 05:03 PM - It Cannot Be Edited

Created By: Noemi Galarza On 03/03/2026 at 04:12 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: ELIM SILVERTOWN	FACILITY NUMBER: 198603774
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87608(a)(5)(B)

Postural Supports

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that resident (R1's) bed has full bed rails that extend the entire length of the bed, and the resident was discharged from hospice on 12/30/25, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/04/2026
	Plan of Correction
1 2 3 4	Staff removed the full-size bed rails from R1’s bed. Please submit a copy of the half size bed rails physician order along with a picture by tomorrow.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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

	Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:

	Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2026

LIC809 (FAS) - (06/04)

Page: 5 of 7

Document Has Been Signed on 03/03/2026 05:03 PM - It Cannot Be Edited

Created By: Noemi Galarza On 03/03/2026 at 04:12 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: ELIM SILVERTOWN	FACILITY NUMBER: 198603774
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87307(a)(3)(C)

Personal Accommodations and Services

(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that rooms, 120, 124, 127, 212, 215, 218, 222, 225, 226, 228, 313, 314, 317, 321, 323, 324, 327, 326, 329, 413, 416, 421, 422 & 430 do not have bed mattress pads, they only have disposable incontinence liners, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/24/2026
	Plan of Correction
1 2 3 4	Submit a written plan of correction and proof that mattress pads have been purchased for and placed on beds in rooms, 120, 124, 127, 212, 212, 215, 218, 222, 225, 226, 228, 313, 314, 317, 321, 323, 324, 327, 326, 329, 413, 416, 421, 422 & 430.

Type B

Section Cited

CCR

87309(c)

Storage Space and Access Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that R2's room had vitamins in resident's nightstand without a physician order in centrally stored medication records, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/10/2026
	Plan of Correction
1 2 3 4	Administrator agreed to address vitamin storage in resident's room and obtain a physician order.

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

	Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:

	Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2026

LIC809 (FAS) - (06/04)

Page: 6 of 7

Document Has Been Signed on 03/03/2026 05:03 PM - It Cannot Be Edited

Created By: Noemi Galarza On 03/03/2026 at 04:43 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: ELIM SILVERTOWN	FACILITY NUMBER: 198603774
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87463(h)

Reappraisals (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that resident (R1, R5, R7) medical assessments are more than 12 months old, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/24/2026
	Plan of Correction
1 2 3 4	Submit copies of R1, R5 & R7 medical assessments.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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

	Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:

	Noemi Galarza
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2026

LIC809 (FAS) - (06/04)

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