415601052-9-2-2021-14-AS-KHOS-C73JAU-20210921065319

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 09/02/2021
Date Signed: 09/02/2021 11:46:57 AM

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
04/16/2021 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20210416151733

FACILITY NAME:	SILVER OAKS		FACILITY NUMBER:	415601052
ADMINISTRATOR:	RUBIO, NANCY		FACILITY TYPE:	740
ADDRESS:	16 COLEMAN PLACE		TELEPHONE:	(707) 592-1157
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY:	43	CENSUS: 31	DATE:	09/02/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Nancy Rubio		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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-Authorized representative did not receive a copy of the admission agreement
-Administrator did not refund authorized representative

INVESTIGATION FINDINGS:

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On this day at 1030hrs, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to deliver findings in the allegations received. LPA met with administrator Nancy Rubio and explained purpose of today's visit.

During the course of the investigation interviews were conducted and documentation is reviewed. It is discovered that the responsible party of the resident did receive a hardcopy of the admission agreement from the facility via mail. In regards to the refund, the facility does have a 30 day written policy for termination of services and an additional clause stating that if due to health condition they are no longer able to provide care, the facility will discontinue billing. It's discovered that a verbal 30 day notice was given on 12/02/20 and the responsible party moved the resident to another facility with a health condition the facility could provide care for. The month of December 2020 was paid for in advance but the 30 day notice also was given on 12/02/20 and the resident moved out on 12/24/20 which is eralier than 30 days. These allegations are unfounded.

This agency has investigated the above allegations. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.”

Report is reviewed with administrator.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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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