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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157201417
Report Date: 01/22/2024
Date Signed: 01/23/2024 08:34:29 AM


Document Has Been Signed on 01/23/2024 08:34 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, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:SILVERLAKE HOMEFACILITY NUMBER:
157201417
ADMINISTRATOR:NEBRIDA, OFELIAFACILITY TYPE:
740
ADDRESS:3303 SILVERLAKE DRIVETELEPHONE:
(661) 829-5349
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:4CENSUS: 4DATE:
01/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:33 AM
MET WITH:Ofelia NebridaTIME COMPLETED:
02:42 PM
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On 1/22/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self, stated purpose of visit, and allowed entrance by Administrator, Ofelia Nebrida, Certificate # 6031630740, expires 6/18/2024.

There are currently four (4) residents in care. All residents were present during today's inspection. Residents attend in home day program, Monday through Friday 8:00 AM - 2:00 PM. Residents observed participating in educational activities during inspection visit.

Facility tour conducted with Administrator. Facility observed to be clean, odor free, and a comfortable temperature. Facility has adequate seating and lighting for residents in both the living room and dining room areas. All resident bedrooms observed to be furnished with all required furnishings. Bathrooms toured, showers observed to have shower grab bars, shower chairs, and non-slip mats. Toilet areas also have grab bars Water temperature measured at 112 degrees F during inspection. Kitchen toured, facility observed to have adequate food supply for residents in care. All sharps are locked and secured in kitchen drawer. Cleaning supplies observed to be locked and secured under kitchen sink and additional supplies are locked and secured in garage. Laundry room is also locked, secured, and inaccessible to residents. Garage is utilized for additional storage of supplies and observed to be locked, secured and inaccessible to residents. Medications observed to be locked and secured in kitchen cabinet. Medication reviewed and observed to have original labels, and to be administered as prescribed. Fire extinguisher present with a service date of 7/31/23. Carbon monoxide detector and smoke detector observed operational during inspection. Last fire drill conducted on 1/12/24 according to facility records.

Outside of facility toured. All exits open free of obstruction. No hazards observed.

LPA received copies of Administrator certificate, LIC 308, LIC 9020, and certificate of liability insurance during today's visit.

No deficiencies observed during inspection.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2024
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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