<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600869
Report Date: 12/03/2024
Date Signed: 12/03/2024 12:48:08 PM

Document Has Been Signed on 12/03/2024 12:48 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SILVERADO SENIOR LIVING - BELMONT HILLSFACILITY NUMBER:
415600869
ADMINISTRATOR/
DIRECTOR:
ROBERT SNEEFACILITY TYPE:
740
ADDRESS:1301 RALSTON AVETELEPHONE:
(650) 654-9700
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY: 112TOTAL ENROLLED CHILDREN: 0CENSUS: 81DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Administrator, Robert SneeTIME VISIT/
INSPECTION COMPLETED:
01:00 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 December 3, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual visit. LPA met with Administrator, Robert Snee and explained the purpose of the visit.

LPA toured facility and grounds including but not limited to, five resident neighborhoods; maple, cedar, bay, twin pines and oak, one main administrative office, library, and kitchen. No accessible bodies of water or fire safety hazards observed. LPA toured resident neighborhoods and observed a dining room in each neighborhood. Dining room and hallways were clean and free from any tripping hazards. Resident rooms were observed clean, odor-free, with all required furniture. Nurses station was observed in the Oak and Maple neighborhood. Medications were observed to be locked and inaccessible to residents. First aid kits were observed to be present and complete. Toxins and chemicals were locked and stored away in a storage room.

Water temperature throughout the facility measured between 105-115 degrees F. Communal bathrooms were observed to be clean and odor-free. Kitchen was observed two day perishables and seven day non-perishables. Lighting and temperature throughout the facility was sufficient for comfort. Fire extinguishers were mounted and serviced in 10/2024. Emergency drills are logged and done every three months.

LPA reviewed 5 resident files and 5 staff files. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated.

Report is reviewed with Administrator and a copy is provided.
April CowanTELEPHONE: (650) 266-8889
Komal CharitraTELEPHONE: (650) 629-4305
DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1