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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600900
Report Date: 02/08/2023
Date Signed: 02/08/2023 10:17:55 AM


Document Has Been Signed on 02/08/2023 10:17 AM - 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:
374600900
ADMINISTRATOR:JOSEPHINE I. PADILLAFACILITY TYPE:
740
ADDRESS:8236 WATERVIEW COURTTELEPHONE:
(619) 475-6459
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: 0DATE:
02/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Josie & Benjamin PadillaTIME COMPLETED:
10:29 AM
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced closure visit to the facility. LPA was able to gain entry to the facility after ringing the doorbell. LPA spoke with Administrator Josephine to confirm the closure of the facility.

During the closure visit, LPA observed the facility. LPA did not observe any residents or other individuals. Prior to the closure visit, proper eviction notices and proper relocation of residents was confirmed with responsible parties and current facilities. As of today, no deficiencies were issued and the facility is considered closed. LPA collected the facility license.

A copy of this report and Licensee's Appeal Rights (LIC 9058 03/22) were provided to the Licensee at the conclusion of the visit.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany HolmesTELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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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