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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803538
Report Date: 09/03/2024
Date Signed: 09/03/2024 04:10:43 PM

Document Has Been Signed on 09/03/2024 04:10 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:SILVER RAIN HOME CAREFACILITY NUMBER:
197803538
ADMINISTRATOR/
DIRECTOR:
EUGENE ALANGUIFACILITY TYPE:
740
ADDRESS:1707 SILVER RAIN DR.TELEPHONE:
(909) 861-3438
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY: 6CENSUS: 6DATE:
09/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Eugene Alangui, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the annual inspection on 9/3/24. LPA arrived unannounced and met with administrator, Eugene Alangui. The purpose of the visit was provided. The facility is licensed to serve (6) non-ambulatory residents ages 60 and over. There is an approved hospice waiver.

LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools.
The facility does not have any pools or bodies of water on the premises. There is a total of 4 resident bedrooms, 1 staff room, 2 bathrooms, living room, dining/family room, and an attached garage. The smoke detectors and carbon monoxide detector are operable. Knives and cleaning supplies are locked. Resident bedrooms have sufficient lighting. There is sufficient space to accommodate indoor and outdoor activities. Facility has 2 day perishable and at least a week of non-perishable food.
There are currently 6 residents residing at the facility. LPA reviewed all the residents files and the required documents are maintained in their files. Medications are centrally stored in the cabinet next to the refrigerator. There were no discrepancies found for the meds. The personal rights, complaint and ombudsman posters are posted in a prominent area. LPA reviewed 3 staff files. The administrator's certificate expires on 9/24/24. Staff have current CPR & First Aid certificates. LPA provided technical advisories on annual training for staff.
The Emergency Disaster Plan has been reviewed annually. The facility conducts fire drills and tests the smoke detector monthly. LPA issued a technical advisory on emergency drills in order to satisfy the requirement.

No deficiencies were issued today. An exit interview was conducted. A copy of this report, technical advisories, and appeal rights were given to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2024
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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