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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200975
Report Date: 09/27/2022
Date Signed: 09/27/2022 04:19:02 PM


Document Has Been Signed on 09/27/2022 04:19 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: 0DATE:
09/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Timothy Phillips, Licensee/AdministratorTIME COMPLETED:
04:35 PM
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On 9/27/2022 at around 4:00PM, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct a case management visit due to Licensee's request for decrease capacity. LPA met with Administrator Timothy Phillips, LPA explained the purpose of the visit.

LPA toured the facility.On 9/8/2022 facility received approved fire clearance with capacity of 4 for all bedridden. Facility is now using room #1 (2 residents) and room #2 (2 residents) only.

Facility do not have residents during LPA's visit.

Facility is now approved for NEW CAPACITY OF 4.

No deficiency cited during the visit. Copy of report provided to Administrator.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Leslie IboTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
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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