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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370804404
Report Date: 10/01/2020
Date Signed: 10/01/2020 02:06:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SILVERCREST GUEST HOMEFACILITY NUMBER:
370804404
ADMINISTRATOR:PELINA, AMALIAFACILITY TYPE:
740
ADDRESS:960 GROSSMONT AVENUETELEPHONE:
(619) 442-3957
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:15CENSUS: 11DATE:
10/01/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Amalia Pelina, AdministratorTIME COMPLETED:
02:07 PM
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Licensing Program Analyst (LPA)Tiffany Holmes contacted the facility via tele-virtual/face time visit to follow up on an incident report that was received in the office on 10/01/2020 due to COVID-19. LPA identified herself and discussed the purpose of the call with Administrator Amalia Pelina.

Incident report dated 09/30/2020 regarding Client 1 (C1) (See LIC 811 Confidential Names) AWOLing on 09/24/2020. C1 was last seen at the facility on 09/24/2020 around 10:30AM on the patio. Administrator contacted C1s responsible party and the Sheriff's department to file a missing persons report on 09/24/2020 around 12:15PM. Administrator was informed by a hospital caseworker that C1 was found and taken to the hospital in Los Angeles.

Facility followed the appropriate measures and called the police in a timely manner. Facility also followed their absentee notification plan for C1.

No deficiencies are being cited today during visit.

An exit interview was conducted with Administrator Pelina via face time and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Administrator Pelina via email. An electronic email read receipt confirms the documents were received.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany HolmesTELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2020
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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