415600869-7-31-2025-14-AS-ACON-DLKUWN-20250916155700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600869
Report Date: 07/31/2025
Date Signed: 07/31/2025 12:35:01 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
03/20/2025 and conducted by Evaluator Komal Charitra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20250320161225

FACILITY NAME:	SILVERADO SENIOR LIVING - BELMONT HILLS		FACILITY NUMBER:	415600869
ADMINISTRATOR:	ROBERT SNEE		FACILITY TYPE:	740
ADDRESS:	1301 RALSTON AVE		TELEPHONE:	(650) 654-9700
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY:	112	CENSUS: 88	DATE:	07/31/2025
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Director of Health Services, Amyda Astrero		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident sustained pressure injuries in care.
Due to staff neglect, resident was dehydrated.

INVESTIGATION FINDINGS:

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On July 31, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Director of Health Services, Amyda Astrero and explained the purpose of the visit.

Regarding the allegation, resident sustained pressure injuries in care, according to the reporting party, Resident 1 (R1) was admitted to the hospital on February 19th with open wounds on both heels. R1 had deep tissue pressure injury on the left heel and a wound on the right heel.

During the investigation, LPA interviewed staff, reviewed R1’s file and reviewed medical records. Based on charting notes reviewed, on 2/15/25, the facility reported a right heel wound to R1’s physician and R1’s responsible party. According to R1’s responsible party, it was noted that R1 has a history of pressure ulcer. According to interviewed staff, R1’s physician sent a referral to home health wound nurse, however on 2/19/25, R1 was sent to the ER and was told by R1’s responsible party that home health called to notify R1’s responsible party that they are coming to the facility, however cancelled because R1 was still admitted at the hospital. (continue to 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025

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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Control Number 14-AS-20250320161225

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 HILLS	FACILITY NUMBER: 415600869
	VISIT DATE: 07/31/2025

NARRATIVE

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Based on photos, facility wound care notes, home health wound care notes, and interviews conducted, R1 returned to the community on 3/7/25 with wounds on both heels. Home health wound nurse came into the facility for wound care 3x a week. On 4/11/25, R1 was admitted to hospice.

Regarding the allegation, due to staff neglect, resident was dehydrated, according to the reporting party, R1 was admitted to the hospital on 2/19/25 for dehydration.

During the investigation, LPA interviewed staff. According to staff interviewed, the facility was notified that R1 had a history of dehydration. Because the facility is not a skilled nursing facility, they don't log water intake, however since facility staff were aware of the history of dehydration, the facility staff ensured to monitor R1's water intake. Facility staff indicated that a water bottle was also purchased for R1 so that staff are aware how much water R1 is drinking a day.

Based on interviews conducted, documents reviewed and information collected, the department has determined that although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED.

Report is reviewed with the Director of Health Services and a copy is provided.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025

LIC9099 (FAS) - (06/04)

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