306005494-4-18-2023-22-AS-RMAZ-CQZSMM-20230418140011

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005494
Report Date: 04/18/2023
Date Signed: 04/18/2023 02:00:20 PM

Document Has Been Signed on 04/18/2023 02:00 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
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	SILVER LINING MANOR		FACILITY NUMBER:	306005494
ADMINISTRATOR:	FADDOUL, LACY		FACILITY TYPE:	740
ADDRESS:	425 ARCHER ST		TELEPHONE:	(949) 682-5229
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	6	CENSUS: 5	DATE:	04/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Lacy Faddoul		TIME COMPLETED:	02:20 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 Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual inspection. LPA arrived at the facility was greeted and granted entry by Miriam Esquivel, House Manager. Six residents currently reside at this location and no residents are on hospice. Lacy Faddoul, Administrator arrived shortly after and met with LPA. LPA accompanied by Administrator began the tour of the inside and outside of the facility. There is a minimum of one week of non-perishable foods and two days of perishable foods available. There is additional food storage in attached garage in refrigerator. The facility is maintained at a comfortable temperature. The hot water temperature measured 109.5 Fahrenheit degrees in residents’ restrooms. Restrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility has an available a clean supply of linen. LPA inspected residents’ bedroom which had sufficient lighting to ensure safety and comfort. Storage space is provided for residents. LPA checked if medications are centrally stored in a safe locked cabinet location in kitchen. LPA reviewed medication. Residents’ medication was labeled and stored inaccessible to the residents. LPA inspected and observed that toxic chemicals, cleaning solutions and disinfectants are locked and inaccessible to residents. LPA toured the second floor of the facility, which is inaccessible to residents in care. There are no residents residing on the second floor. Smoke detectors and alarms were tested and operational. LPA toured the outside parameters of facility and observed outdoor passageways are free of obstruction. Disaster drills are conducted every quarter, the last drill was performed on February 16, 2023. Facility has a covered patio with seating for residents’ enjoyment. LPA spoke with alert residents regarding the quality of their care. LPA reviewed staff, fingerprint records. All employees have a criminal record clearance. During the inspection, LPA reviewed six Continued on LIC809-C

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SILVER LINING MANOR	FACILITY NUMBER: 306005494
	VISIT DATE: 04/18/2023

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resident records and four staff records. LPA was informed only two residents out of the six resident have P&I funds. LPA checked residents P&I funds, each resident balance matched with the ledger account and the funds were accurate.

Based on the observations made during today’s visit, no deficiencies were noted in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with facility representative and a copy of this report was provided and left at facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

LIC809 (FAS) - (06/04)

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