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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320131
Report Date: 09/27/2023
Date Signed: 09/27/2023 10:51:02 AM


Document Has Been Signed on 09/27/2023 10:51 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:SILVERADO ROLLING HILLSFACILITY NUMBER:
198320131
ADMINISTRATOR:LOURDES MENCHACAFACILITY TYPE:
740
ADDRESS:2455 PACIFIC COAST HWYTELEPHONE:
(424) 488-0593
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:68CENSUS: 42DATE:
09/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Administrator Olivia M. BlaylockTIME COMPLETED:
11:25 AM
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On 09/27/2023 at 8:05 am Licensing Program Analyst (LPA) David España conducted an unannounced required annual visit. Upon arriving at the facility, LPA met with the Administrator Olivia M. Blaylock and Maria Soto, Director of Association, Training and Education who assisted with the visit. LPA explained the purpose of today’s visit. Upon arrival at the facility, LPA David España conducted a risk assessment at the front door. Based on the assessment, the facility is not cleared of COVID-19 infection. There is a total of 21 COVID-19 cases, and seven 7 COVID-19 active cases at the time of visit.

LPA requested for staff roster, resident roster, COVID-19 roster, and COVID-19 cleared roster. LPA conducted Inspection Staff interviews with two (2) out two (2) staff.

Due to COVID-19 infection outbreak a subsequent case management visit is required.

An exit interview was conducted, and a copy of this report was provided to the Administrator, Olivia Blaylock.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
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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