<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200975
Report Date: 01/05/2024
Date Signed: 01/05/2024 09:39:18 AM


Document Has Been Signed on 01/05/2024 09:39 AM - 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:
01/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Timothy Phillips, AdministratorTIME COMPLETED:
09:45 AM
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
On 01/05/2024 at 09:15AM, Licensing Program Analysts (LPAs) L. Hall and T. Syess-Gibson conducted an unannounced Case Management visit regarding closure of facility. LPA met with Timothy Phillips, Administrator, and explained the purpose of the visit.

Upon arrival LPAs toured facility to confirm all residents had been relocated. The Administrator stated the last resident moved on August 2, 2023. LPA collected the facility's license.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura HallTELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1