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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600869
Report Date: 01/31/2024
Date Signed: 01/31/2024 10:42:04 AM


Document Has Been Signed on 01/31/2024 10:42 AM - 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: 65DATE:
01/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Administrator, Robert SneeTIME COMPLETED:
11:00 AM
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On January 31, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero 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 clear for hazards. Resident rooms observed had all required furniture and were observed to be clean. Nurses station was observed in the Oak and Maple neighborhood. Medications were observed to be locked. First aid kits were observed to be present and complete. Three laundry rooms and one main laundry room was observed to be locked. Toxins and chemicals were locked and stored away in a storage room. Water temperature throughout the facility measured between 112-118.9 degrees F. Six communal bathrooms were observed to be clean and odor-free. Kitchen was observed to be clean. Kitchen was observed two day perishables and seven day non-perishables.

Lighting throughout the facility was sufficient for comfort. A comfortable temperature of 71 degrees F is maintained. Fire extinguishers were mounted and serviced in 10/2023. Emergency drills are logged and done every three months.

LPA reviewed 5 resident records and 5 staff records. 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.

No citations are observed during the visit. Report is reviewed with the Administrator and 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: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
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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