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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700133
Report Date: 09/26/2022
Date Signed: 09/26/2022 01:30:35 PM

Document Has Been Signed on 09/26/2022 01:30 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:SILVER PINES CARE HOME I LLCFACILITY NUMBER:
342700133
ADMINISTRATOR:LOESCH, DEBBIEFACILITY TYPE:
740
ADDRESS:8625 HUME COURTTELEPHONE:
(916) 686-1936
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 6DATE:
09/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Debbie LoeschTIME COMPLETED:
01:35 PM
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 Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual inspection. LPA Valerio met with facility staff, and stated the purpose of today’s visit. Licensee arrived at the facility shortly after LPA.
 
The physical plant was toured inside and outside to ensure the safety of the residents and compliance with Title 22 regulations. The infection control tool was completed during the visit. The facility has an Infection Control Plan and a Monkey Pox Infection Control Plan on file that meets department regulations. Staff training are up to date.
 
LPA observed the temperature inside the facility was measured at 74 *F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 105.6 *F. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPA Valerio observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, central heating, and air in the facility. A first aid kit and an emergency supply of food/water was observed. LPA observed the tool sheds in the backyard. Tools and sharps were observed to be locked up.
 
Facility licensee sent LPA required annual documentation prior to inspection.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed or cited.  Exit interview held with Administrator Debbie Loesch, and a report was left at the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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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