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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803538
Report Date: 09/26/2023
Date Signed: 09/26/2023 11:44:05 AM


Document Has Been Signed on 09/26/2023 11:44 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:SILVER RAIN HOME CAREFACILITY NUMBER:
197803538
ADMINISTRATOR:EUGENE ALANGUIFACILITY TYPE:
740
ADDRESS:1707 SILVER RAIN DR.TELEPHONE:
(909) 861-3438
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:6CENSUS: 6DATE:
09/26/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Emelita Alangui, Co-AdministratorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the annual inspection. The initial inspection started on 9/19/23. The Co-Administrator, Emelita Alangui, arrived shortly to assist with the visit.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools to complete the annual inspection. The following were observed:
Staffing: Per the administrator, there is sufficient staffing. There are 2 live-in caregiver who provide care and supervision to residents.
Personnel Records/Staff Training: Staff files are maintained at the facility. The administrator, Eugene Alangui, certificate expires on 9/24/24. Per administrator, they provide proper training to all staff when first hired and annually. LPA observed some training logs signed by staff in participation for this year.
Resident Records/Incident Reports: LPA reviewed all 6 resident files. They contain the required documents such as Admission Agreement signed, Physician's Report, reappraisals, personal rights, and consent forms.
Resident Rights/Information: Facility has the postings with information on appropriate reporting agencies.
Incidental Medical and Dental: LPA reviewed medications for all 6 residents and there are no discrepancies observed.
Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D) in place.
Resident with Special Health Needs: The facility accepts and retains residents with dementia and on hospice care.

No deficiencies issued today. An exit interview was held and a copy of this report was given to the administrator.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023
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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