<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700133
Report Date: 10/31/2024
Date Signed: 10/31/2024 04:38:41 PM

Document Has Been Signed on 10/31/2024 04:38 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SILVER PINES CARE HOME I LLCFACILITY NUMBER:
342700133
ADMINISTRATOR/
DIRECTOR:		LOESCH, DEBBIEFACILITY TYPE:
740
ADDRESS:8625 HUME COURTTELEPHONE:
(916) 686-1936
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 6DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Debbie LoeschTIME VISIT/
INSPECTION COMPLETED:
04:46 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/31/24, Licensing Program Analyst (LPA) Arvin Villanueva arrived to the facility unannounced to conduct an annual required inspection. LPA met with staff on duty (S1) and explained the purpose of the visit. The Licensee/Administrator Debbie Loesch and Assistant Administrator Ingrid Myers arrived shortly after. Upon arrival, there were 6 residents in care with 1 staff on duty (S1).

LPA evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair at this time. LPA observed 3 bedrooms to be equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the hot water temperature measured at 110 degrees F in the hallway bathroom. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguisher observed in the kitchen/dining was last inspected on 1/4/24. Smoke and carbon monoxide detectors were observed, tested and operable at this time. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. Swimming pool was observed to be fenced, locked and inaccessible to residents in care. No bodies of water was observed at this time. Fireplace is not being used.

Due to insufficient time,this annual visit will require a continuation visit.

Exit interview was conducted with the Administrator and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
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)
Page: 1 of 1