366425833-6-15-2021-18-AS-EWEY-C3ZSQR-20210615140509

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366425833
Report Date: 06/02/2021
Date Signed: 06/15/2021 02:05:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	SILVERCARE HOMES		FACILITY NUMBER:	366425833
ADMINISTRATOR:	ROLANDO/ZENAIDA SERQUINIA		FACILITY TYPE:	740
ADDRESS:	25117 LAWTON AVENUE		TELEPHONE:	9097961223
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	6	CENSUS: 6	DATE:	06/02/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Administrator, Rolando Serquinia		TIME COMPLETED:	01:53 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's (LPA) Elecia Weathersby made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Weathersby arrived and was greeted and granted entry by the Administrator, Rolando Serquinia. Administrator confirmed that there are currently no cases/exposures of COVID-19 in the facility. During the inspection, LPA Weathersby conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures. The facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a 30+ day supply of Personal Protective Equipment (PPE). LPA Weathersby also observed that all staff members were properly fitted with face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining clients, and properly caring for clients with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the client presents any COVID-19 symptoms. Narrative continued on next page, 809C

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia Weathersby	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SILVERCARE HOMES	FACILITY NUMBER: 366425833
	VISIT DATE: 06/02/2021

NARRATIVE

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LPA Weathersby observed staff member Josephine Rivera's adult daughter "Zoe" enter the facility unannounced, through a back sliding glass door without signing in or completing COVID-19 screening. Caregiver Rivera's daughter "Zoe" does not appear to reside in the facility. Verbal warning given to Administrator Serquinia. LPA educated facility Administrator Serquinia and staff member Rivera, on the sign in policy and clearance requirements for all adults who visit staff at the facility. LPA Weathersby identified no other health and safety concerns at the time of visit. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview was conducted where this report was discussed, and a copy of this report was also provided to Administrator, Rolando Serquinia. at the conclusion of the inspection.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia Weathersby	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

LIC809 (FAS) - (06/04)

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