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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200938
Report Date: 12/28/2021
Date Signed: 12/28/2021 12:43:53 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: 78DATE:
12/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Robert Snee, AdministratorTIME COMPLETED:
12:55 PM
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On 12/28/2021 Licensing Program Analyst (LPA) L. Holmes and Licensing Program Manager (LPM ) Y. Flores-Larios arrived unannounced to conduct a case management visit. LPA and LPM met with Robert Snee, Administrator and explained the purpose of the visit was to gather more information regarding incident reports received on 12/06/2021 involving three different residents.

LPA conducted interview with Administrator and reconfirmed actions that the facility is taking to ensure residents safety. Requested corrected incident report to be sent to CCL.

No deficiency cited

Exit interview conducted with Jeff Emoruwa, Director of Health Services and copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
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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