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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600869
Report Date: 05/05/2022
Date Signed: 05/05/2022 10:09:24 AM

Substantiated


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
02/17/2022 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20220217094555
FACILITY NAME:SILVERADO SENIOR LIVING - BELMONT HILLSFACILITY NUMBER:
415600869
ADMINISTRATOR:JOAN D NEWMANFACILITY TYPE:
740
ADDRESS:1301 RALSTON AVETELEPHONE:
(650) 654-9700
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:112CENSUS: 66DATE:
05/05/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Interim Executive Director, Robert SneeTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Facility is not following COVID protocols
INVESTIGATION FINDINGS:
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On May 5, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the above allegation. LPA met with interim Administrator, Robert Snee, and Director of Health Services, Glynis Marcantel joined shortly therafter. LPA explained the purpose of the visit.

Regarding the allegation that facility is not following COVID protocols, the complainant alleged that residents who had tested COVID positive were able to roam around the facility, dine and commingle with COVID negative residents. During the investigation, LPA reviewed facility COVID mitigation plan and interviewed staff members and it was indicated that there is a dedicated isolation unit at the facility for those who test positive for COVID, however the Administrator at the time did not want to move the positive residents, reserving the isolation area for residents who required higher level of care. In addition, interviewed staff indicated that because the residents have dementia, it was difficult to isolate them in their rooms, but the facility staff did try to ensure the positive residents were not in close proximity to the negative residents.

Based on the documentation collected and interviews conducted, the facility failed to follow COVID protocols, therefore the preponderance of evidence standard has been met; therefore, this allegation is Substantiated.

Deficiency of the Residential Care Elderly California Code of Regulations, Title 22, Division 6 is observed and cited on a LIC 9099D. Failure to correct the deficiencies may result in civil penalties.

Report reviewed with the interim Administrator and the Director of Health Services and a copy is provided with the appeals rights is provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
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
02/17/2022 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20220217094555

FACILITY NAME:SILVERADO SENIOR LIVING - BELMONT HILLSFACILITY NUMBER:
415600869
ADMINISTRATOR:JOAN D NEWMANFACILITY TYPE:
740
ADDRESS:1301 RALSTON AVETELEPHONE:
(650) 654-9700
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:112CENSUS: DATE:
05/05/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Interim Administrator, Robert SneeTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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2
3
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5
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8
9
Facility does not have enough staff to provide care and supervision for COVID positive residents in the designated COVID isolation unit.
INVESTIGATION FINDINGS:
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5
6
7
8
9
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12
13
On May 5, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the above allegation. LPA met with interim Administrator, Robert Snee, and Director of Health Services, Glynis Marcantel joined shortly therafter. LPA explained the purpose of the visit.

Regarding the allegation that the facility does not have enough staff to provide care and supervision for COVID positive residents in the designated COVID isolation unit, the complainant indicated that the facility had an isolation area but lacked staff to support it. During the investigation, LPA interviewed staff members and it was indicated that during this time there was a staffing shortage, however the isolation unit of the facility was not used because the Administrator at the time wanted to use the area for residents requiring higher level of care, and not due to staffing shortages. The information collected shows that at the height of the pandemic, the facility struggled with staffing issues just as many other facilities, and supplemented shortages with staffing agencies.

Therefore, based on the information collected and interviews conducted, the allegation that the facility does not have enough staff to provide care and supervision for COVID positive residents in the designated COVID isolation unit is UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove that the alleged violation occurred.

Report reviewed with the interim Administrator and the Director of Health Services and a copy is provided with the appeals rights is provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 14-AS-20220217094555
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SILVERADO SENIOR LIVING - BELMONT HILLS
FACILITY NUMBER: 415600869
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2022
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include ... services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
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Administrator or designated staff to conduct an in-staff training in relation to COVID-19 protocols. Facility to submit an updated LIC808 Mitigation Plan for CCLD's approval IF facility has changed their covid mitigation plan.
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Based on the documentation collected and interviews conducted, the facility failed to isolate COVID positive residents in the designated isolation unit at the facility. In addition interviewed staff indicated that because residents have dementia, it was difficult to isolate residents in their rooms but staff did try to ensure the positive residents were not in close proximity to the negative residents. This poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3