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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208956
Report Date: 10/31/2024
Date Signed: 10/31/2024 03:14:41 PM

Document Has Been Signed on 10/31/2024 03:14 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/
DIRECTOR:		GARDINER, RACHAELFACILITY TYPE:
740
ADDRESS:4439 W HAROLD AVETELEPHONE:
(559) 690-3986
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 6CENSUS: 1DATE:
10/31/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:43 PM
MET WITH:Rachael GardinerTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 10/31/24 Licensing Program Analyst (LPA) M. Medina conducted an unannounced Case Management Health Check visit. LPA arrived, introduced self, stated purpose of visit, and allowed entrance by Licensee/Administrator, Rachael Gardiner.

This Department received a call on 10/31/24 that Resident 1 (R1) was present with supervision. Facility toured. LPA observed one resident (R1) to be sitting in their bedroom. Facility observed to be clean, well lit, and a comfortable temperature.

LPA observed the following during facility visit:
1) Absence of supervision
2) Facility did not have a 2-day supply of perishable or a 7-day supply of non-perishable food available
3) No qualified Administrator

This Department will contact licensee to schedule a meeting in the Fresno Regional Office. Deficiencies observed during today's Case Management visit will be addressed during the meeting.

No deficiencies issued.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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