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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200938
Report Date: 04/01/2021
Date Signed: 04/01/2021 04:33:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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-BERKELEYFACILITY NUMBER:
019200938
ADMINISTRATOR:SNEE, ROBERTFACILITY TYPE:
740
ADDRESS:2235 SACRAMENTO STREETTELEPHONE:
(949) 240-7200
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:90CENSUS: 61DATE:
04/01/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Robert Snee, Executive DirectorTIME COMPLETED:
04:35 PM
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On 4/1/2021 at 2:35pm, Licensing Program Analyst (LPA) L. Francisco conducted a pre-licensing televisit via Zoom due to shelter in place directed by the Governor. LPA met with Executive Director, Robert Snee. The facility's fire clearance was approved for all may be non-ambulatory which 62 may be bedridden.

During the Tele-Inspection, LPA toured facility with Executive Director including but not limited to random resident rooms, bathrooms, communal shower room, common areas, laundry room, kitchen, dining area, activity rooms and outdoor area. Resident's rooms are fully furnished with bed, dresser, night stand, and chair. Facility currently has 61 residents. Communal shower room and private full bathrooms were equipped with grab bars and non-skid mats. LPA observed lighting in all rooms. Medications in cart were observed to be locked. Smoke detectors, carbon monoxide and sprinklers were observed throughout the facility. First aid kit is complete. LPA advised Administrator that hot water temperature should be maintained between 105 degrees F and 120 degrees F. Indoor and outdoor passageways were free of obstruction. Fire extinguisher was last serviced on 3/8/2021. Room temperature was maintained at 72 degrees F. Facility has sufficient supply of 2 day perishables and one week non-perishable food.

Comp III is being waived.

This report will be submitted to the Centralized Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

Exit interview conducted with Executive Director and a copy of report will be emailed.

SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Lizette FranciscoTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2021
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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