306005453-3-29-2022-22-AS-JALE-CCZ2NE-20220329173238

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005453
Report Date: 03/29/2022
Date Signed: 03/29/2022 05:32:49 PM

Document Has Been Signed on 03/29/2022 05:32 PM - 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	SILVER LINING RESIDENTIAL CARE		FACILITY NUMBER:	306005453
ADMINISTRATOR:	FADDOUL, LACY		FACILITY TYPE:	740
ADDRESS:	1243 N. BROOKHURST STREET		TELEPHONE:	(661) 810-7293
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	14	CENSUS: 9	DATE:	03/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:48 PM
MET WITH:	Lacy Faddoul		TIME COMPLETED:	05:50 PM

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	Licensing Program Analysts (LPAs) Joseph Alejandre and Jessica Cho conducted an unannounced annual visit to the Silver Lining Residential Care. The purpose of the visit was to conduct the required annual inspection (mitigation). LPAs were greeted and granted entry and met with Administrator Lacy Faddoul and Administrator's Assistant, Iulia Perez. The Administrator's Certificate expires on 5/9/2022. Facility is licensed for 6 ambulatory, 8 non-ambulatory, and approved waiver for 2 hospice residents. The facility consists of a two story building with 8 bedrooms and 3 bathrooms with a living room, dining room, and a kitchen on the first floor. The second floor is inaccessible and locked to the residents and has 1 bedroom and a bathroom with a bonus room, office, kitchenette, and an attic. LPAs toured the facility with the administrator. LPAs observed all residents' rooms met all regulatory compliance, except for the following: the air conditioning/heating vent in the ceiling in Bedroom #1 is not properly secured to the ceiling and hanging loose. At this time, the a/c vent is secured by tape until repair is permanent. Bed rails in Bedrooms #3 & #5 had chipped paint. The door trim in Bath #1 had water damage. It needs to be repaired or replaced. Nightstand in Bedroom #2 had chipped paint on the bottom shelf. Smoke/carbon monoxide detectors tested operational. Bathrooms were clean and operational. Hot water in Bathroom 3 measured 129 degrees Fahrenheit, Bathroom 2 measured 126 degrees Fahrenheit, Bathroom 1 measured 124 degrees Fahrenheit. LPAs observed in the entrance way the table/shelf mounted on the wall has come loose and is not securely attached to the wall. The kitchen was clean and organized. LPAs observed a 2 day perishable and a 7 day non-perishable of foods. The stove was lighted unassisted. Knives were locked in the tool box inside the drawer. Medications are locked in a drawer in the kitchen island. LPAs observed the front yard has a seating area. The front exit gate is kept secured. Around the side of the house, there is a locked storage shed that contains wheelchairs, ladder, and other supplies. The backyard has a covered patio with a seating area. LPAs and Administrator toured the detached 2 car garage. The garage is kept locked and contains laundry supplies and washers and dryers. LPAs toured the second floor which is off limits and inaccessible to residents. LPAs did not observe hazards or violations in the second floor/staff quarters. Facility's mitigation plan has been approved. LPAs consulted with the Administrator continuing COVID-19 mitigation procedures and reporting requirements.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

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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Document Has Been Signed on 03/29/2022 05:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SILVER LINING RESIDENTIAL CARE	FACILITY NUMBER: 306005453
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(e)(2)

Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degrees F (41 degree C) and not more than 120 degree F (49 degree C).
	Deficient Practice Statement
1 2 3 4	This requirement is not being met as evidenced by: LPAs measured the hot water in 3 out of 4 bathrooms (the 4th bathroom is upstairs in staff quarters). The hot water measured in B1 is 124 degrees Fahrenheit, B2 is 126 degrees Fahrenheit, B3 is 129 degrees Fahrenheit. This poses a potential health and safety risk to the residents in care.
	POC Due Date: 04/01/2022
	Plan of Correction
1 2 3 4	Licensee states the hot water temperature will be adjusted to meet the regulatory requirements by the POC due date. Licensee states the hot water will continue to be monitored on a weekly basis. Proof of the water temperature checks to be provided to the LPAs via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SILVER LINING RESIDENTIAL CARE	FACILITY NUMBER: 306005453
	VISIT DATE: 03/29/2022

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 26 27 28 29 30 31 32	Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report along with citations and Appeal Rights (LIC 9058 01/16) was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022

LIC809 (FAS) - (06/04)

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