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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208956
Report Date: 05/27/2022
Date Signed: 05/27/2022 09:47:00 AM


Document Has Been Signed on 05/27/2022 09:47 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, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:SILVER HOUSE ASSISTED LIVINGFACILITY NUMBER:
547208956
ADMINISTRATOR:GARDINER, RACHAELFACILITY TYPE:
740
ADDRESS:4439 W HAROLD AVETELEPHONE:
(559) 936-2891
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:6CENSUS: 5DATE:
05/27/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Manager Becki Winters and TIME COMPLETED:
10:00 AM
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Licensing Program Analyst LPA conducted a Case Management to follow up on an incident report that occurred on 3/25/22. LPA was met by Staff Becki Winters and discussed the purpose of the visit. Administrator Rachael Gardiner responded to the facility to assist with the visit.


LPA took resident's file to copy and will return by the end of the day. LPA's interviewed staff.



An exit interview was conducted with the Administrator Rachael Gardiner.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/27/2022
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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