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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208956
Report Date: 08/26/2024
Date Signed: 09/03/2024 10:49:03 AM


Document Has Been Signed on 09/03/2024 10:49 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) 690-3986
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:6CENSUS: 1DATE:
08/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Rachel GardinerTIME COMPLETED:
11:15 AM
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On 8/26/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self, stated purpose of visit, and allowed entrance by care staff. Licensee/Administrator, Rachael Gardiner also present at time of arrival.

One resident present at time of inspection. Resident observed to be seating in the back yard at time of LPA arrival.

Facility tour conducted with Licensee. Facility observed to be clean, odor free, and a comfortable temperature. Facility has adequate seating and lighting for residents in both the living room and dining room areas. Resident bedroom observed to be furnished with all required furnishings. Bathrooms toured, showers observed to have shower grab bars, shower chairs, and non-slip mats. Toilet areas also have grab bars Water temperature measured at 112 degrees F during inspection. Kitchen toured, facility observed to have adequate food supply for resident in care. All sharps are locked and secured in kitchen drawer. Cleaning supplies observed to be locked and secured in garage. Medications observed to be locked and secured in kitchen cabinet. Medication reviewed and observed to have original labels, and to be administered as prescribed. Carbon monoxide detector and smoke detector observed operational during inspection.

Outside of facility toured. All exits open free of obstruction. No hazards observed.

LPA advised during inspection that facility will providing notice to families regarding closure of facility no later than 11/30/2024.

No deficiencies observed during inspection.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2024
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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