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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496802047
Report Date: 04/25/2024
Date Signed: 04/25/2024 11:31:15 AM


Document Has Been Signed on 04/25/2024 11:31 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



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: 6DATE:
04/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH:Joel Trinidad (Licensee)TIME COMPLETED:
11:46 AM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with Licensee, Joel Trinidad. Required postings were observed. Annual fees are current.

LPA/Licensee initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature with thermostat in the hallway reading at 72 degrees F. Passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathroom measured at 105.4 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Toxins were locked under kitchen sink. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked in a hallway closet. Fire extinguisher was last inspected August, 2023. Smoke alarms and carbon monoxide detectors were tested and operational during inspection. Exit doors have auditory alert system that was functional at time of visit. The facility does not handle cash resources. Last disaster drill was conducted on April 1, 2024.

File review was initiated at 9:30 am. Four staff files and five resident files were reviewed. Staff have required First Aid certificates. All staff have required training hours. Administrator Certificate for Administrator, Joel Trinidad 6022722740 expires 11/22/2024. Medications and medication records were reviewed.

Licensee to submit updates of the following documents by 5/2/2024: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), Emergency Disaster Plan (LIC610E if any changes) and copy of Liability Insurance.

No deficiencies cited during today's inspection. Exit interview conducted with Licensee and a copy of this report was given.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2024
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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