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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200975
Report Date: 07/13/2022
Date Signed: 07/13/2022 02:35:35 PM


Document Has Been Signed on 07/13/2022 02:35 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:SILVER CREST HOMECAREFACILITY NUMBER:
079200975
ADMINISTRATOR:PHILLIPS, TIMOTHYFACILITY TYPE:
740
ADDRESS:204 CHAPS COURTTELEPHONE:
(925) 252-5117
CITY:OAKLEYSTATE: CAZIP CODE:
94561
CAPACITY:6CENSUS: 1DATE:
07/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Timothy Phillips, Administrator/LicenseeTIME COMPLETED:
03:00 PM
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On 7/13/2022 1:40PM, Licensing Program Analyst (LPA) Leslie Ibo conducted an infection control annual inspection and explained the purpose of the visit with Administrator Timothy Phillips. LPA observed 1 hospice resident during the visit. Facility has a completed infection control plan. LPA inspected the facility inside and outside of the facility. LPA observed COVID-19 signage posted in common areas to promote hand washing, cough/sneeze etiquette and physical distancing. Pathways were observed to be free of obstruction and fire hazards.

Infection control designated leader is the Administrator. There was at least 7 days of nonperishable and 2 days of perishable foods. Facility room temperature was maintained at 72 degrees Fahrenheit. A certified Administrator is on site a minimum of 20 hours a week to oversee proper business operation. Smoke and Carbon monoxide detectors were operational.

Administrator informed LPA that he applied to reduce facility capacity from 6 to 4 and increase hospice waiver. Application was sent to CCL office last week of June 2022.

No deficiency cited during the visit.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie IboTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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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