Art of Living Silvertown

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual inspection visit on 01/09/2026 and was greeted by Caregiver Bokki Jung. LPA Ramirez identified herself and explained the purpose of the visit. The facility is located on a residential street and is a single-story dwelling. Video surveillance was observed in common areas. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: During tour of facility, LPA Ramirez observed green rubbing alcohol on a nightstand next to R3's bed. Per caregiver S2, R3 uses rubbing alcohol for personal grooming. During resident record review, R3's physician documented that R3 may not have items of personal grooming accessible to them for safety reasons. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected six (6) resident rooms and two (2) resident bathrooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed no-slip coating in showers. LPA Ramirez observed seated shower chairs in bathroom. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Six (6) out of the six (6) residents in care speak and read in another language (Korean). Administrator Kim will post a Complaint Poster (PUB 475) in language spoken by residents. see 809-C Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in pantry. No proof of documented emergency drills was provided when requested. Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. During facility tour, LPA Ramirez observed six (6) out of six (6) resident beds had full bed rails. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication cart and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate for Hyo Sook Kim with an expiration date of 04/18/2027 was observed. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files were made available upon request. Personnel records for S2 & S4 including job application were left blank. During personnel record review, S2 & S4 did not have documentation of First Aid/CPR training in their files. S4's documentation of training dates and hours were left blank. Infection Control: Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) non ambulatory residents over the age of 59 years old, of which three (3) may be bedridden. This facility may retain no more than six (6) hospice residents. There was one (1) resident on hospice during time of inspection. Resident Records/Incident Reports: LPA reviewed resident records for six (6) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. Five (5) deficiencies were observed during this visit. Exit interview conducted. A copy of this report, 809-D, LIC 9102, and appeals rights was provided.the state’s words, verbatim · CDSS document, Jan 9, 2026

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Administrator Monica Kim and the purpose of the visit was explained. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. An Infection Control Plan was observed Physical Plant/Environment Safety: The facility is a single-story home: Total of (9) bedrooms of which #1-#6 is for residents only and #7-#9 are staff rooms and office spaces, (3) bathrooms, dining room, (2) living rooms, backyard with locked detached garage, and a laundry area. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are enclosed ponds in the backyard. Water temperature readings measured within title 22 regulations. Operational Requirements: A current Plan of Operation observed. Dementia Care Plan Observed A fire clearance for 6 residents of which (6) may be non ambulatory and up to three (3) bedridden Hospice care waiver approved for up to six (6) residents. Facility has an active liability insurance. Copy was collected and reviewed Personnel Records - Staff Training: Administrator on file is current. Administrator certificate is currently active Five (5) staff files were reviewed. Required documents observed for files reviewed. Staffing: Sufficient staff observed during visit Continued on LIC 809-C Resident Records - Incident Reports: A total of six (6) resident files were reviewed. Required documents observed Resident Rights - Information Required postings observed Facility provides internet services to residents in care Food Service: Sanitation practices and kitchen cleanliness was observed. Kitchen has utensils for clients to use and to store their meals Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Activities supply observed Incident Medical and Dental: Emergency transportation available First Aid Kid observed (5) of (6) Resident medications reviewed. (1) Resident has their medication handled by family. Disaster Preparedness: Emergency and Disaster Plan observed Emergency drills conducted per title 22 guidelines Residents with Special Health Needs: Needs and Services Plans are on file for all residents. Currently (2) residents receiving home health services. Written agreement of services observed. (0) Residents are on hospice. Inspection Tool was completed and per Title 22 no deficiencies are being cited on todays visit. Exit interview conducted. Copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 3, 2025

Type of visit: Office

Licensing Program Analyst (LPA) Jose Villalobos and Licensing Program Manager (LPM) Fernando Fierros conducted an informal office meeting with Hyo Sook Kim (Monica) Administrator for Art of Living Silver Town and Julie Coreas Office Manager. The meeting is to discuss the citations issued on the facility dated 8/22/24 and 9/3/2024. LPM discussed the following regulations and provided copies of the regulations to Administrator: Title 22 Regulation 87412 Personnel Records Title 22 Regulation 87465 Incidental Medical and Dental Care Title 22 Regulation 87355 Criminal Record Clearance Title 22 Regulation 87202 Fire Clearance Title 22 Regulation 87204 Limitations - Capacity and Ambulatory Status Title 22 Regulation 87307 Personal Accommodations and Services Title 22 Regulation 87458 Medical Assessment Health & Safety Code 1569.618 Administration and Management of Resident Care Facilities... Note: Facility has since cleared deficiencies issued on previous visits Current Census is (6) residents of which three (3) are non-ambulatory, three (3) are ambulatory and zero (0) bedridden. Administrator stated to LPM and LPA that they are interested in receiving more information regarding the departments Technical Support Program (TSP). Monica also expressed interest in increasing the facility capacity. LPM and LPA informed Monica that an updated facility sketch designating number of residents per room and an LIC 200 Increase of Capacity form would be needed from the Licensee on file. Exit Interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 27, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Jose Villalobos conducted a Plan Of Correction Visit (POC) to follow up on deficiencies cited on the case management visit conducted on 9/3/24. Upon arriving at the facility, LPA met with Staff Okkyung Coreas and explained the purpose of this visit as well as explained to administrator Hyo Kim via phone call. LPA Villalobos verified the following deficiencies cited on 9/3/24 to be cleared: CCR 87202(a) Facility to relocate residents to approved resident rooms by POC due date. LPA observed residents that were residing in the staff room on the previous visit are now in cleared resident rooms. Deficiency is cleared at the time of this visit. All above citations are cleared at the time of this visit. No further citations provided on this report. Exit Interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 16, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Jose Villalobos conducted a Plan Of Correction Visit (POC) to follow up on deficiencies cited on the Post-Licensing visit conducted on 8/22/24. The purpose of this visit is to follow-up on the POC's that were due on 08/23/24. Upon arriving at the facility, LPA met with staff Eun Kee Byun and explained the purpose of this visit as well as explained to administrator Hyo Kim via phone call. LPA Villalobos verified the following deficiencies cited on 8/22/24 to be cleared: CCR 87465(h)(5) Facility to return medications to pill bottles contact pharmacy to discharge medications removed from bubble packs by POC due date. LPA observed medications to be in order. Deficiency Cleared. CCR 87355(e)(4) Administrator associated the staff via guardian during the visit. Deficiency was cleared during the initial visit. CCR 87465(h)(2) Administrator placed medications in locked medications cart. Deficiency was cleared during the initial visit CCR 87204(a) Licensee to create and follow plan of relocating residents until they reach the proper capacity they are licensed for by POC due date. LPA to conduct follow up visit to verify. 9/3/24 LPA Villalobos conducted POC Visit and observed facility capacity to be within approved License amount. POC is cleared. CCR 87307(a)(2)(B) Facility to place Resident #8 in an approved bedroom or relocate resident to proper placement by POC due date. LPA Villalobos to conducted follow up visit to verify. 9/3/24 LPA Villalobos conducted POC Visit and observed deficiency to be cleared. All above citations are cleared at the time of this visit. No further citations provided on this report. Exit Interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 3, 2024

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jose Villalobos conducted Case Management - Deficiencies visit as a result of observed deficiency during POC visit on the same day. LPA met with staff Eun Kee Byun and explained the purpose of this visit as well as explained to administrator Hyo Kim via phone call. During the visit, LPA Villalobos observed residents #1 and #2 to be living in a room designated as a staff room. Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 1. Immediate Civil Penalty is being assessed. See attached 809-D page. Exit interview was conducted, appeal rights discussed. A copy of this report and the appeal rights were also provided.the state’s words, verbatim · CDSS document, Sep 3, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Sep 4, 2024

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This was not met as evidenced by: Resident #1 and Resident #2 were living in a room designated as a staff room not cleared for resident occupation, this poses an immediate health and safety risk to residents in care and supervision.the state’s words, verbatim · CDSS document, Sep 3, 2024

Plan of correction: Facility to relocate residents to approved resident rooms by POC due date. LPA to conduct follow up visit to verify.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Jose Villalobos arrived unannounced to conduct an Post Licensing inspection. LPA met with staff Reina Rojas who allowed entry into the home. The purpose of the visit was discussed. Administrator Hyo Kim arrived shortly after. The Facility is licensed for six (6) residents who may be non-ambulatory, of which up to three (3) may be bedridden. Fire clearance for bedridden residents may be in Rooms #2-#4. Hospice Waiver approved for up to six (6) residents in care. Dementia care plan is in place. The inspection was completed using the CARE tools. Observations: LPA toured and inspected a total of (9) rooms. Bedrooms #1-#6 was used for residents #1-#7 (R1-R7), Resident #8 (R8) is using the living room as their bedroom, and staff room was being used for Residents #9-10 (R9-R10). The facility is operating over its licensed capacity. LPA continued tour and observed (2) rooms used as a staff office and staff supply/break room. There are (3) bathrooms, (1) dining room, (2) living rooms, backyard with locked detached garage, and a laundry area. Sharps were observed secured in locked. The facility was free of odor, clean and in good repair. No obstructions were noted in hallways or living areas. Sufficient furniture and lighting was observed throughout the facility. LPA reviewed plan of operation. personnel policies reviewed and discussed. Reporting requirements were discussed. This included abuse reporting procedures. (10) Resident file records were reviewed. Resident files all had admissions agreements but missing various other documents such as physicians reports and appraisals. Continued on LIC 809-C (4) Staff records were reviewed. (2) Files requested by LPA were unavailable as they had not been created by the administrator. Per Title 22, All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. LPA checked criminal record clearances and staff #1 (S1) is not cleared or associated to this facility. Centrally stored medications were reviewed. LPA observed R3, R7, and R8 to have medication out in common areas. Medications observed were also popped out and prepared into weekly boxes. In-service training's and medication procedures were not logged. See Something Say Something complaint poster, Evacuation Routes and facility license were all posted as required. Deficiencies noted and citations issued per the California Code of Regulations, Title 22, Division 6, Chapter 8, which includes immediate civil penalties. Please see the attached LIC 809D. Immediate Civil Penalty was assessed. Per Title 22, Division 6 ,Chapter 8 (f) Violation of Section 87355(e) shall result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the department. Civil Penalties were assess at $300 for this violation. Additionally, immediate civil penalties were assessed in the amount of $500, due to a Fire Clearance Violation. Exit interview conducted. Appeal rights were discussed with Administrator Hyo Kim. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 22, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jose Villalobos conducted an announced pre-licensing visit and met with Applicant Hyo Sook (Monica) Kim. The purpose of the visit was discussed. An application for an Initial License was submitted to the department on 9/13/23. The facility will operate as a Residential Care Facility for the Elderly (RCFE). The facility has a total capacity to serve up to six (6) Residents. Fire clearance approved for six (6) residents who may be non-ambulatory, of which up to three (3) may be bedridden. Fire clearance for bedridden residents may be in Rooms #2-#4. Hospice Waiver approved for up to six (6) residents in care. Dementia care plan is in place. The facility is a single-story home: Total of (9) bedrooms of which #1-#6 is for residents only and #7-#9 are staff break rooms and office spaces, (3) bathrooms, dining room, (2) living rooms, backyard with locked detached garage, and a laundry area. The physical plant was toured. Pre-Licensed Inspection Tool was used. The following was observed/inspected: · There is a locked storage area that is centrally located for medication. · Cleaning supplies are kept separate from food and located in a locked cabinet. · Facility walls, ceilings, floors, window screens and areas around the facility are clean and in good repair. · Fire extinguishers and smoke/CO2 detectors operate properly. · Doors and passageways are free of obstruction. · There are no pools/bodies of water at the facility. · Facility does not have firearms on premises. (Continued on 809-C) · All Required Postings were observed. · There is an emergency exiting plan with emergency phone numbers posted. · Facility has a current Emergency disaster plan maintained at the facility. · Operating telephone is on the premises and will be available to residents. · Locked area for Staff and Residents files observed.. · First-aid supplies are maintained and readily available. · Refrigerator and freezer were observed and are maintained at the correct temperatures. · Food storage and preparation are clean and appropriate for food preparation. · Hot water temperature was tested and is within the required range of 105-120 degrees F. · Plan of Operation / Dementia Care Plan / Infection Control Plan observed Facility plant cleared on todays visit. Component III was completed with Applicant Monica Kim as well. An exit interview was conducted, and a copy of this report has been furnished to applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Jan 9, 2024

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Hyo Sook Kim, Administrator Byunk Hak Yoo, Applicant Interview Method: Virtual interview (Microsoft Teams) On November 15, 2023 at 11:00 AM, Applicant and Administrator participated in COMP II. Identification of the Applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. During COMP II, CAB analyst confirmed Applicant and Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicant and Administrator. Report sent via email and informed to return sign copy back to CAB by end of business day today.the state’s words, verbatim · CDSS document, Dec 15, 2023

Type of visit: Office

Component II completion: Unsuccessful Facility Type: Residential Care Facility for Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Hyo Sook Kim, Administrator Byunk Hak Yoo, Applicant Interview Method: Telephone interview Virtual interview ( Microsoft Teams) On November 27, 2023, applicant and administrator participated in COMP II. Previous dates 10/23/2023, 11/1/2023, and 11/20/2023. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During the COMP II, applicant and/or administrator did not provide sufficient knowledge of the program and/or community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Component II will be rescheduled to December 15, 2023 at 9:00 AM.. Exit interview conducted with Applicant and Administrator. Report sent via email and informed to return signed back to CAB by end of business day today.the state’s words, verbatim · CDSS document, Nov 27, 2023