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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
547208956
Report Date:
11/15/2024
Date Signed:
11/15/2024 11:39:08 AM
Document Has Been Signed on
11/15/2024 11:39 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
FRESNO RO
,
1314 E SHAW AVE
FRESNO
,
CA
93710
FACILITY NAME:
SILVER HOUSE ASSISTED LIVING
FACILITY NUMBER:
547208956
ADMINISTRATOR/
DIRECTOR:
GARDINER, RACHAEL
FACILITY TYPE:
740
ADDRESS:
4439 W HAROLD AVE
TELEPHONE:
(559) 690-3986
CITY:
VISALIA
STATE:
CA
ZIP CODE:
93291
CAPACITY:
6
CENSUS:
1
DATE:
11/15/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:
Rachael Gardiner
TIME VISIT/
INSPECTION COMPLETED:
12:02 PM
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LPA, L. Xiong at the above facility for a case management visit. LPA met with licensee and discuss with her the current situation/operation of the facility.
SUPERVISORS NAME
:
Melinda Hoffmann
LICENSING EVALUATOR NAME
:
Les Xiong
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/15/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/15/2024
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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