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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496802047
Report Date: 06/17/2021
Date Signed: 06/17/2021 01:32:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:SILVA BOARD AND CAREFACILITY NUMBER:
496802047
ADMINISTRATOR:TRINIDAD, JOELFACILITY TYPE:
740
ADDRESS:1130 SILVA AVETELEPHONE:
(707) 542-3500
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:6CENSUS: 5DATE:
06/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:37 PM
MET WITH:Administrator, Joel TrinidadTIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPA) Victoria Willis and Erik Gonzalez Campos arrived unannounced, to conduct an annual required inspection and were greeted by administrator, Joel Trinidad. The inspection is focused on the Infection Control procedures and practices of this facility.

Upon arrival, LPAs were screened by staff and screening was documented. LPAs initiated walk-through of the facility with administrator at 1:00 PM and observed COVID-19 posters throughout that included hand washing signs. Facility was a comfortable temperature and exits were free from obstructions. Infection control has been discussed with residents and staff. Hand sanitizer is located throughout the facility for resident and staff use. Commonly touched surfaces are disinfected on each shift.

Facility had a recent fire inspection on June 2, 2021. No issues were noted.

Common areas are set up for social distancing. Facility has a designated visitation area. Staff have completed PPE training and but have not been N95 fit tested.

COVID mitigation plan was reviewed and approved during visit. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, face shields, gowns and hand sanitizer. Facility maintains a 30 day supply of medication.

Facility has 100 percent vaccination rate of staff and residents so may discontinue surveillance testing.

According to Administrator, they have reviewed PINs 21-17-ASC and 21-17.1-ASC for new guidance regarding visitation, communal dining, etc.



LPAs reminded Licensee that live-in staff must wear masks while in general areas of the facility.

Administrator and LPAs discussed their Emergency Disaster Plan.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
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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