019200709-1-19-2023-15-AS-KHOS-CNDPMF-20230124102615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200709
Report Date: 01/19/2023
Date Signed: 01/19/2023 11:35:36 AM

Unsubstantiated

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
12/24/2020 and conducted by Evaluator Lisha Holmes

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20201224083234

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: 73	DATE:	01/19/2023
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Jeff Emoruwa, Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Facility not following CDC guidelines in regards to infection control
Facility does not have adequate staff

INVESTIGATION FINDINGS:

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On 01/19/23 at 10:35 AM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced subsequent complaint visit to deliver the findings for the above allegations. LPA explained the purpose of the visit with Jeff Emoruwa, Administrator.

Allegations:
Facility not following CDC guidelines in regards to infection control.
Facility does not have adequate staff
Investigation Findings: UNSUBSTANTIATED

Based on record reviews and interviews, the facility followed Provider Information Notice PIN-20-48-ASC guidelines. Interviews and records revealed that the facility addressed epidemic outbreaks and concerns specific to COVID-19 infection control which included isolation procedures, donning and doffing instructions and increased staffing.
...continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
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.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20201224083234

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: 01/19/2023

NARRATIVE

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...continued from LIC9099

Interviews, records, invoices, calendars, and timesheets for December 2020 further revealed what appeared to be adequate staffing levels and scheduling for Care, Culinary, Engagement, and Plant Operations. Love to Care and Healthcare services were contracted to supplement the staffing levels. The Staff interviewed (S1, S2, S6, S7) all stated they had enough Personal Protective Equipment (PPE); S8 stated he/she did not have enough PPE. S1 stated that PPE was purchased in bulk for all the communities by the corporate office. Purchase orders and invoices revealed that thousands of personal protective equipment, including but not limited to N95 respirators, KN95’s, head shields, surgical masks, gloves, gowns and thermometers were purchased by the facility.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted. A copy of this report provided to Administrator, Jeff Emoruwa.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
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

LIC9099 (FAS) - (06/04)

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