019200709-11-18-2021-15-AS-KHOS-C9CRP3-20211203121115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200709
Report Date: 11/18/2021
Date Signed: 11/18/2021 12:28:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/08/2021 and conducted by Evaluator Laura Hall

COMPLAINT CONTROL NUMBER: 15-AS-20210108144504

FACILITY NAME:	SILVERADO SENIOR LIVING - BERKELEY		FACILITY NUMBER:	019200709
ADMINISTRATOR:	SNEE, ROBERT E		FACILITY TYPE:	740
ADDRESS:	2235 SACRAMENTO ST		TELEPHONE:	(510) 841-4844
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	0	CENSUS: 75	DATE:	11/18/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Robert Snee, Administrator		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Facility has inadequate staff

Personal Rights - Facility failed to assist resident communicate with family

Personal Rights - Facility cancelled once a month meeting with Resident Council

INVESTIGATION FINDINGS:

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On 11/18/2021 at 10:30AM, Licensing Program Analysts (LPAs) L. Hall and Jill Clancy-Czuleger arrived unannounced to conduct investigation and deliver complaint findings for the above allegations. LPAs met with Robert Snee, Administrator, and explained the reason for the visit.

During the course of the investigation, LPAs conducted interviews with staff, obtained and reviewed documents. On the allegation facility has inadequate staff. Based on record review the facility hired staff from three (3) different staffing agencies for the months of December 2020 and January 2021 to assist in the shortage of staff during the COVID outbreak. LPAs obtained copies of the invoices from the agencies that indicated names, dates, and times of the hired staff.

Continued on LIC9099.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20210108144504

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: SILVERADO SENIOR LIVING - BERKELEY	FACILITY NUMBER: 019200709
	VISIT DATE: 11/18/2021

NARRATIVE

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Continued from LIC9099.

On the allegation facility failed to assist resident communicate with family. Based on record review and interviews facility used FaceTime, Zoom, residents own devices, and facility telephone for residents to communicate with their families. LPAs obtained Zoom and FaceTime records that indicated names and times of calls. Facility did not have records of residents using their own devices or the facility telephone to communicate. During interview with S3, it was stated that S3 along with S4 would schedule Zoom and FaceTime calls, however, other staff would assist as needed with residents communicating with their families.

On the allegation facility canceled once a month meeting with Resident Council. Interviews with S1 and S2 indicated facility has not had a resident council meeting in approximately five (5) years. S1 stated that there is a group of Residents’ Responsible Party’s that meet outside of the facility and collectively bring any concerns or ideas to facility staff. During interview S3 stated staff meets with residents to discuss social programs and events to add to monthly calendar. Staff sends a copy of the calendar to family members to get feedback.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has not been met, therefore the allegations are found to be UNSUBSTANTIATED, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove it did or did not occur.

Exit interview conducted and a copy of report provided.

SUPERVISOR'S NAME: Harpreet Humpal	TELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Laura Hall	TELEPHONE: (510) 622-2024
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

LIC9099 (FAS) - (06/04)

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