Mugunghwa Silvertown

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA met with Administrator, Jessica Watanabe, and explained the purpose of the visit. Licensee, Eugene Choi, arrived shortly thereafter to join the visit. The facility is licensed for 56 residents, of which 24 may be non-ambulatory. The non-ambulatory residents are approved for the 1st floor only. The facility is a two-story building. The first floor consists of the administrator’s office, resident bedrooms, dining area, kitchen, activity room, laundry room, and medication room. There is a covered outdoor area. The second floor consists of resident bedrooms and an activity room. There is one elevator on the premises. The smoke detectors are interconnected and linked to the fire department. Food supplies are sufficient. There are no items obstructing the walkways. The facility is clean and free of odor. The hot water temperature was measured within 105-120 degrees F. The liability insurance is maintained at $1,000,000 per occurrence and $3,000,000 in total annual aggregate. LPA reviewed 6 resident files and their medications. Medications are given as prescribed by the physician. Resident files have a physician's report and reappraisal form, however, LPA issued a technical violation for not having them reassessed every 12 months or sooner. LPA reviewed 3 staff files. The administrator’s (Hyun Joo Watanabe) certificate expires on 11/18/27. Staff did not have current First Aid and/or CPR certificates. Facility did not have the updated Emergency Disaster Plan (LIC610E) and did not document drills conducted. Deficiencies are issued on the LIC809D. An exit interview was held with the administrator. A copy of this report, along with appeal rights, was provided.the state’s words, verbatim · CDSS document, Jun 26, 2026

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Elena Mallett conducted an unannounced Case Management visit to the facility to review the files of Staff #1-Staff #5 (S1-S5) . LPA met with Administrator Hyun Joo Watanabe (aka Jessica Shin) and the purpose of the visit was explained. Licensee Eugene Choi joined the visit at 10:30 AM. Upon review of the staff files LPA observed the following: S1 has been the Licensee/Executive Director since 2018 and has a criminal background clearance but is not associated to the facility. S2 has worked as a Housekeeper since 12/27/2021 and has a criminal background clearance but is not associated to the facility. S3 has worked as a Housekeeper at the facility since 03/07/2026 with no criminal background clearance and is not associated with the facility. S4 has worked as Kitchen staff at the facility since 03/04/2022 with no criminal background clearance and is not associated with the facility. S5 has worked as Kitchen staff at the facility since 03/17/2023 with no criminal background clearance and is not associated with the facility. . Per Title 22 a deficiency will be cited today , see 809-D, and Civil penalties will be assessed in the amount of $500 per staff member. The total civil penalty amount is $2,500.00. An exit interview was conducted with Licensee Eugene Choi and Administrator Hyun Joo Watanabe (aka Jessica Shin) and a copy of this Licensing report was provided along with Appeal rights.the state’s words, verbatim · CDSS document, May 18, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: May 19, 2026

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review...(3) Request a transfer of a criminal record clearance as specified in Section 87355(c) The above requirement was not met as evidenced by S1 and S2 were not assoicated to the facility in LIS or Guardian. The facility did not transfer S1 and S2 criminal record clearance. This poses an immediate health and safety risk to all residents in care.the state’s words, verbatim · CDSS document, May 18, 2026

Plan of correction: By POC due date, Administrator will submit a signed statement of understanding of the regulation cited and fax it to office Fax. S1 and S2 will not resume work at the facility until S1 and S2 are associated in Guardian.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(2) · Plan of correction due date: May 19, 2026

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review ...(2) Obtain a California clearance or a criminal record exemption as required by the Department The above requirement was not met as evidenced by S3,S4 and S5 were working at the facility and were not cleared and assoicated to the facility in Guardian. Facility did not obtain a criminal record clearance for S3,S4 and S5. This poses an immediate Health and safety risk to residents.the state’s words, verbatim · CDSS document, May 18, 2026

Plan of correction: By POC due date Administrator will fax a signed statement of understanding of the cited regulation to LPA via the office Fax. S3, S4 and S5 will not resume work at the facility until facility obtains a criminal background clearance for S3, S4 and S5 and assoicates S3, S4 and S5 to the facility in Guardian.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Elena Mallett made an unannounced Case Management visit to facility to review staff files. LPA was met by Licensee Eugene Choi and the purpose of the visit was explained. LPA requested and obtained goverment IDs from S1,S2,S3,S6,S7,S8,S9,S10. LPA requested and obtained job applications for S3,S4,S7,S9 and S10. Due to time constraints, visit will be continued on another day An exit interview was conducted with Licensee Eugene Choi and a copy of this Licensing Report was provided.the state’s words, verbatim · CDSS document, May 7, 2026

Allegation investigated: Facility only admits residents based on race.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to deliver findings on the above-mentioned allegation. LPA met with Licensee Eugene and Administrator Jessica and explained the reason for the visit. The investigation consisted of: On 2/22/24 LPA Alma Gonzalez conducted the initial 10-day visit and requested a copy of Staff and Resident rosters, LPA conducted a phone interview with Licensee Eugene Choin and an interview with Administrator Jessica Watanabe, and toured entire facility inside and out with Administrator. On 3/4/24 LPA Gonzalez conducted a subsequent visit to gather information pertaining to allegation and obtained copies of Staff and Resident Rosters. LPA conducted interviews with Staff 1-3 (S1-3) and Residents 1-5 (R1-5). LPA additionally requested copies of documents pertinent to the investigation. On 8/21/25 LPA Tena Herrera conducted a subsequent visit to deliver findings for the above allegation. (Continued on the LIC9099-C page) Unsubstantiated The investigation revealed the following: Allegation: Facility only admits residents based on race. It is alleged that the facility turned away individuals that were interested in moving in for not being Korean. LPA Gonzalez conducted 5 staff interviews in total, and each denied the above allegation, all 5 Staff stated that they have never discriminated against anyone for any reason, including race. Each staff confirmed they have been provided with non-discrimination training and have never observed another staff discriminating towards any of the residents or potential residents. All 5 staff additionally stated that there are other races besides Korean that live at the facility. LPA Gonzalez obtained a list of Non-Korean residents that have resided at facility from 2017-2023 (3 of which are still currently residing at facility). LPA Gonzalez interviewed 5 Residents and 5 out of 5 Residents denied the above allegation and stated that they have never felt discriminated against, interviews with R3 and R4 stated that there are individuals that are not of Korean descent that live at the facility. Interview with Licensee Eugene Choi explained that although the facility is known in the Korean community this is mainly because many of the facilities residents used to live in Koreatown and preferred to stay close to the neighborhood, a google search to see how far facility is from Koreatown it confirmed there is a 1.7 mile distance from facility location to Koreatown. Based on statements and interviews conducted with staff/residents and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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. Exit interview held, and a copy of this report was emailed to mugunghwasilvertown@gmail.comthe state’s words, verbatim · CDSS document, Aug 21, 2025 · control 28-AS-20240216083741

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection on 5/23/25. LPA met with licensee, Eugene Choi, and explained the purpose of the visit. The administrator, Jessica Watanabe, also assisted with the visit. The facility is licensed for 56 residents, of which 24 may be non-ambulatory. The non-ambulatory residents are approved for the 1st floor only. The facility is a two-story building. The first floor consists of the administrator’s office, resident bedrooms, dining area, kitchen, activity room, laundry room, and medication room. There is a covered outdoor area. The second floor consists of resident bedrooms and an activity room. There is one elevator on the premises. The smoke detectors are interconnected and linked to the fire department. Food supplies are sufficient and are purchased at least 4 times a week. There are no items obstructing the walkways. The facility appears clean and free of odor. The hot water temperature was measured within 105-120 degrees F. The facility could not provide proof of the liability insurance covering injuries in the amount of at least $1,000,000 per occurrence and $3,000,000 in total annual aggregate. LPA reviewed 5 resident files and their medications. The files have the required documents. Medications are centrally stored in the med room. LPA observed that the evening medications for Resident #1 were not given for approximately 8 days and Resident #3 was not given the Mirtazapine medication daily. LPA reviewed 4 staff files. The administrator’s (Hyun Joo Watanabe) certificate expires on 11/18/25. Staff #2 did not have a completed health screening on file. The administrator confirmed that staff did not receive training during the 2024 year. LPA provided a technical violation for not having emergency drills conducted at least quarterly for each shift. The deficiencies are issued on the LIC809D. An exit interview was held with the administrator. A copy of this report, along with appeal rights, was provided.the state’s words, verbatim · CDSS document, May 23, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(f) · Plan of correction due date: Jun 6, 2025

87411 Personnel Requirements - General (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in which staff #2 did not have a health screening done upon hire which posesd a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: The licensee shall ensure all employees have a health screening performed by a physician on file and ensure that Staff #2 obtains a health screening by due date 6/6/25.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: May 30, 2025

On and after July 1, 2015, all residential care facilities for the elderly...shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above in which the liability insurance was not available upon request which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: The licensee shall ensure the liability insurance is maintained for the facility at all times. The proof of insurance with the required amount shall be submitted to LPA by 5/30/25.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.625(b)(2 · Plan of correction due date: May 30, 2025

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in staff were not given the annual 20 hours training which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: The licensee shall ensure that the staff are receiving training during the year to fulfill the requirements. A statement acknowledging this regulation shall be submitted to LPA by 5/30/25.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 24, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in 2 of the residents' medications were not given as ordered by the physician which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: The licensee shall ensure the medications are being given as prescribed by the physician. An in-service training shall be given to all staff handling medications and submit the log to LPA by 5/24/25.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alma Gonzalez conducted an annual inspection visit. LPA was allowed entry by Administrator Jessica Watanabe. LPA discussed the purpose of today’s visit. . The facility is licensed to serve (56) elderly residents of which 24 may be non-ambulatory. There are currently three (3) non-ambulatory residents in placement. All non-ambulatory residents are only on the 1st floor. The facility is a two story building which consists of the following: 12 resident rooms located on the first floor and 16 resident rooms located on the second floor. The 1st floor consist of the kitchen, dining room, activity room and medication room. The second floor consists of resident rooms and one resting room for residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility does has an Infection Control Plan in place. Operational Requirements: Facility is adhering to the operational requirements. Physical Plant & Environment Safety: LPA toured facility grounds. The furniture in the dining room was adequate and the kitchen was clean. The appliances were working properly. The refrigerators and freezer are set at appropriate temperatures. LPA toured resident rooms which were randomly chosen for inspection on both floors. There are smoke detectors and fire extinguishers located throughout the building. The hallways and stairways are clear and free of any obstructions. Resident rooms were observed to be clean, properly furnished and have the required linen which were in good condition. There was adequate lighting throughout the facility. All resident rooms had appropriate storage for resident's personal belongings. The bathrooms have the required grab bars near the **Continued on LIC809C** toilet and in the shower. Showers also have non-skid materials. The hot water was tested and was between in random resident rooms and was between 105.2 - 110.4 degrees, which is within Title 22 regulations. Restrooms were observed to be clean, and operational. There is 1 elevator and the elevator was operating at the time of the visit. There is no pool or large bodies of water on the premises. A comfortable temperature was maintained throughout the facility. Staffing: Facility is adhering to staffing requirements. Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for Facility Administrator and Staff 1-3 (S1-3). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Resident Rights-Information: Resident rights are posted and included in Resident files. Planned Activities: Activity schedule is posted. Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. Posted menu observed. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining areas have adequate seating. Resident Records-Incident Reports: LPA reviewed Resident files for Resident 1-4 (R1-4). Resident files are maintained at the facility. Resident files have the required documents. Disaster Preparedness: The facility has a Disaster Preparedness plan in place. Residents with Special Health Needs: Per Administrator, there are no residents with postural supports and no residents with prohibited health conditions. Per Administrator, there are (0) residents utilizing oxygen equipment. Health Related Services/Incidental Medical Services: The medications are stored/ locked inside the medication room and are inaccessible to residents. Exit interview conducted, and a copy of this report was provided to Administrator Jessica Watanabe.the state’s words, verbatim · CDSS document, Jul 1, 2024