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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608180
Report Date: 10/26/2021
Date Signed: 10/26/2021 03:29:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:SILVERADO SENIOR LIVING - THE HUNTINGTONFACILITY NUMBER:
197608180
ADMINISTRATOR:SAFOORA AHMEDFACILITY TYPE:
740
ADDRESS:1118 N STONEMAN AVETELEPHONE:
(626) 308-9777
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:62CENSUS: 30DATE:
10/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Safoora Ahmed, AdministratorTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted an annual inspection with the emphasis on infection control. LPA arrived unannounced and met with Administrator Safoora Ahmed to explain the purpose of the visit. The facility is licensed to serve 62 bedridden residents ages 60 and over and provides dementia care. There is an approved hospice waiver for 10 residents.

LPA Chan and Administrator toured the facility at 1:25pm. The following were observed or inspected:
* The receptionist screens all visitors upon entry and temperature are taken and logged.
* LPA randomly selected 6 rooms to inspect. Rooms #157, #160, and #167 are on the first floor. Rooms #203, #216, and #258 are on the second floor. All the rooms inspected had the required furnishings. The hot water temperature were tested in each of those rooms and are within the range of 105-120 degrees F.
* Soap and paper towels are available in the rooms and in common areas.
* Hand sanitizers station are placed throughout the facility.
* The facility has a sufficient food supply of 2-day perishable and a week of non-perishable. Foods are covered and handled properly to avoid cross contamination.
* Fire extinguishers were last tested on 3/8/21.
* Staff were observed wearing face coverings.
* LPA reviewed 6 Clients' files and all have the updated emergency contact information and physician's report.
* LPA reviewed 4 Staff files. All have the criminal record statement and are associated to the facility.
* Medications are centrally stored and locked.
* The facility has at least 30 days of PPE supplies on the premises.

There were no deficiencies observed during the visit today. An exit interview was held and a copy of this report along with the appeal rights were given to the Administrator.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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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