415600869-11-12-2021-14-AS-CSMH-CLR2HG-20221202162443

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600869
Report Date: 11/12/2021
Date Signed: 11/12/2021 02:04:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/07/2021 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20210707130755

FACILITY NAME:	SILVERADO SENIOR LIVING - BELMONT HILLS		FACILITY NUMBER:	415600869
ADMINISTRATOR:	JOAN D NEWMAN		FACILITY TYPE:	740
ADDRESS:	1301 RALSTON AVE		TELEPHONE:	(650) 654-9700
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY:	112	CENSUS: 69	DATE:	11/12/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Glynis Marcantel		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not assisting resident with hygiene needs
Resident's bathroom was dirty and malodorous
Linens were not provided for resident's bed
Food served to residents not of the quality to meet their needs

INVESTIGATION FINDINGS:

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On this day at 1100hrs Licensing Program Analysts (LPA) Jaime Vado and Komal Charitra conducted an unannounced visit to deliver findings on the allegations received. LPAs met with resident serviced direct Glynis Marcantel regarding the findings.

During the course of the investigation LPA Vado conducted made facility observations and observed R1 and her room. LPA Vado made additional observations on this day regarding resident foods and observed the buildings and grounds including resident rooms and the room of R1. R1 was observed in her bed during these observations and did not want to get out of bed. Linens are in place during these observations. The restroom of R1 was observed but LPA did not detect any odors or see any unwashed resident items in the restroom. LPA observed lunch was and saw many fresh food items served to residents such as salad, salmon, brown rice, vegetables, and fruit. LPA also inspected facility food supplies and menu and observed all are in place. During observations R1 did appear clean in clothing and hygiene needs. LPA asked about hygiene concerns and facility is able to meet her needs and R1 mostly complies when it comes to daily hygiene. Facility cannot force resident to wash hair or cut These allegations are unsubstatiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.

Report is reveiwed with Glenis

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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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