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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600869
Report Date: 12/18/2020
Date Signed: 12/22/2020 02:15:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SILVERADO SENIOR LIVING - BELMONT HILLSFACILITY NUMBER:
415600869
ADMINISTRATOR:JOAN D NEWMANFACILITY TYPE:
740
ADDRESS:1301 RALSTON AVETELEPHONE:
(650) 654-9700
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:112CENSUS: 89DATE:
12/18/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:56 PM
MET WITH: Glynis Marcantel & Joan Newman TIME COMPLETED:
04:30 PM
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On December 18, 2020, Licensing Program Analyst (LPA) Shabana Buksh conducted an unannounced case management inspection. This monitoring inspection was conducted to ensure compliance with the compliance plan discussed with Licensee on 02/29/2020 during the Non - compliance meeting held at San Bruno Office. LPA was given a virtual tour of the facility by Director of Health Service, Glynis Marcantel.

LPA discussed with Executive Director, Joan Newman regarding facility's protocol on elopement prevention, pressure injury prevention and fall prevention which includes appraisal and re-appraisals of residents, identifying and meeting residents’ needs, plan of care, physical plant safety, residents personal rights, staff training and staff monitoring and medication monitoring plan.

As per the compliance plan, this inspection will be conducted frequently. LPA sent the report to Administrator for review and signature.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Shabana BukshTELEPHONE: (650) 266-8810
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
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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