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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157201417
Report Date: 01/19/2023
Date Signed: 01/20/2023 08:37:54 AM

Document Has Been Signed on 01/20/2023 08:37 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:SILVERLAKE HOMEFACILITY NUMBER:
157201417
ADMINISTRATOR:NEBRIDA, OFELIAFACILITY TYPE:
740
ADDRESS:3303 SILVERLAKE DRIVETELEPHONE:
(661) 829-5349
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 4CENSUS: 4DATE:
01/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Ofelia NebridaTIME COMPLETED:
01:48 PM
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On 1/19/2023, Licensing Program Analysts (LPA) M. Medina arrived at the facility unannounced to conduct a Annual Required inspection. LPA was greeted by Direct Care Staff, stated the purpose of the visit and were allowed entry into the facility. COVID precautionary measures were taken at the time of entry. Front door is facility main entry point, Administrator, Ofelia Nebrida contacted by telephone and arrived a short time later to conduct inspection.

Facility Mitigation plan has been submitted to CCL. Infection control procedures described in the plan were observed by LPA. Facility has postings for all visitors upon entry, COVID questionnaire, hand sanitizer, thermometer, and sign-in all available upon entry. Daily symptoms screenings (for staff, persons in care and visitors. Administrator is identified as the Infection Control Lead for the facility.

LPA toured the facility inside and out. Postings to encourage face coverings and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Staff were all observed wearing face coverings. LPA observed 30-day medication supply and PPE accessible to staff. Common and resident bathroom sinks are stocked with liquid soap and paper towels for hand washing.

LPA received copies of Administrator certificate and First Aid card during inspection.

LPA observed the required infection control practices are found to be in compliance. No deficiencies cited during todays visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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