019200938-5-1-2023-15-AS-LHOS-CRF29J-20230501171202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 019200938
Report Date: 05/01/2023
Date Signed: 05/01/2023 05:12:09 PM

Document Has Been Signed on 05/01/2023 05:12 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME:	SILVERADO SENIOR LIVING-BERKELEY		FACILITY NUMBER:	019200938
ADMINISTRATOR:	SNEE, ROBERT		FACILITY TYPE:	740
ADDRESS:	2235 SACRAMENTO STREET		TELEPHONE:	(949) 240-7200
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	90	CENSUS: 76	DATE:	05/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Jeff Emoruwa, Administrator		TIME COMPLETED:	05:30 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 05/01/2023 at 11:00 AM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced annual required inspection. LPA met with Jeff Emoruwa, Administrator and explained the purpose of the visit. LPA toured the facility with ADM who currently holds a certificate (#6049144740) that expires on 08/05/24. The facility’s fire clearance was approved for ninety (90) non-ambulatory residents; sixty-two (62) may be bedridden. Upon arrival LPA observed two (2) staff attending to residents that were playing BINGO and monitoring the facility. LPA and ADM toured the facility including, but not limited to bathroom, kitchen, common areas, medication room, nursing station, laundry room, dining area and courtyard. The facility consists of individual apartments housed by the residents. All outdoor and indoor passageways are free of obstruction. There were no bodies of water. A comfortable temperature was maintained at 73 degrees Fahrenheit (F). LPA observed lighting in all areas to be adequate for the comfort and safety of the residents. Hot water temperature in the shared residents' bathroom was measured at 110.5 degrees (F). All toilets, hand washing, and bathing areas were safe, sanitary and in operating condition. Hand washing signs, paper towels, and soap observed at all hand washing stations. Linen and hygiene product available for all residents. PPE, sanitizer, and paper goods remain sufficient. ...continued on LIC9099C.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 019200938
	VISIT DATE: 05/01/2023

NARRATIVE

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...continued from LIC9099.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was observed full and new tag to be replaced on 05/02/2023. Emergency Disaster Plan is updated. Safety drill was last conducted 03/2023 and are rotational between AM and PM schedules monthly.

Five (5) staff records were reviewed, and all staff have criminal record clearances. Five (5) residents records were reviewed and complete.

No deficiencies cited during visit. Update resident files with safeguards for property/valuables forms by 05/15/2023.

Exit interview conducted and a copy of this report provided to ADM.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC809 (FAS) - (06/04)

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