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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370804404
Report Date: 08/26/2022
Date Signed: 08/26/2022 04:37:19 PM


Document Has Been Signed on 08/26/2022 04:37 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, 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:
08/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Amalia Pelina, AdministratorTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management visit to follow up on deficiencies cited at the facility during a complaint visit on 7/22/22. LPA was granted entry into the facility by Amalia Pelina, Administrator, with whom she discussed the purpose of the visit.

During today's visit, LPA Williamson toured the facility to observed the status of the vermin infestation and the cleanliness of the facility. LPA observed one live cockroach in the office area of the facility on a table, a few mice dropping in the pantry area of the kitchen. Administrator was in the kitchen cleaning out cabinets upon LPA's arrival to the facility. LPA observed glue and mice traps throughout the facility including the kitchen pantry. Administrator stated that the pest control company will be returning to the facility during the end of September 2022.

LPA and Amalia Pelina, Administrator discussed the importance of cleaning the facility. No deficiencies were issued during today's visit.

An exit interview was conducted with Amalia Pelina, Administrator, to whom a copy of this report and the Licensee's/Appeal Rights (LIC9058 01/16) were given.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2022
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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