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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 03:36:14 PM


Document Has Been Signed on 05/27/2022 03:36 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, 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:
03:32 PM
MET WITH:Administrator Rachael GardinerTIME COMPLETED:
03:45 PM
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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 and return R1's file. LPA was met by Administrator Rachael Gardiner and discussed the purpose of the visit.



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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