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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600869
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:51:50 PM


Document Has Been Signed on 01/27/2023 01:51 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:SILVERADO SENIOR LIVING - BELMONT HILLSFACILITY NUMBER:
415600869
ADMINISTRATOR:ROBERT SNEEFACILITY TYPE:
740
ADDRESS:1301 RALSTON AVETELEPHONE:
(650) 654-9700
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:112CENSUS: 60DATE:
01/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Administrator, Robert SneeTIME COMPLETED:
02:00 PM
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On January 27, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual infection control inspection. LPA observed the COVID-19 signage posted on the door of the front lobby. LPA was screened at entry point and observed the visitor screening log documentation. LPA met with Director of Health Services (DHS), Amyda Astrero and Administrator, Robert Snee joined shortly thereafter. Administrator was able to provide screening log documentation for staff and residents to LPA. This facility is a locked memory care facility and the central entry point is the front lobby.

LPA toured the facility and grounds. No accessible bodies of water or fire safety hazards observed. The facility has a total of four different buildings (Twin Pine, Oak, Bay, Cedar/Maple) for residents based on the level of care required. LPA toured the facility with Administrator and DHS and observed the library room. 30-day PPE supply was located in a closet in the library. All communal bathrooms throughout the facility was observed to be equipped with liquid soap, paper-towels, hand washing signs, and a trash can with a fitted lid. LPA toured all four buildings at the facility and observed it to be clean, odorless and free from any tripping hazards. A comfortable temperature of 70-73 degrees F is maintained and lighting is sufficient for comfort. There are a total of four dining rooms at the facility for residents; no toxins, chemicals, or sharps were observed present. LPA observed resident activities calendar posted in the hallways of the resident buildings.

LPA observed two Wellness Centers located at the facility. Wellness Centers had medication locked and stored appropriately and inaccessible to residents. LPA observed the first aid kits in the wellness center to be present and completed. COVID signage was observed to be posted throughout the facility. During the visit, LPA observed staff wearing face masks. LPA observed 4 locked laundry rooms. Toxins and chemicals were observed to be locked and inaccessible to residents. LPA observed additional toxins and chemicals locked outside in the housekeeping storage room. LPA toured and observed the kitchen to be clean and observed 2 day perishable and 7 day non-perishable. There is a locked gate separating the kitchen and the housekeeping storage room from resident buildings.

Infection control practices are observed: COVID signage posted throughout the facility, entry procedures, daily monitoring log for staff, residents and visitors, 30-day PPE supply, face coverings for staff, containment strategies, staff training and policies.

No citations issued during the visit. Report is reviewed with Director of Health Services and a copy is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2023
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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