415601052-10-9-2023-14-AS-KHOS-CX4N6A-20231030101050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 10/06/2023
Date Signed: 10/09/2023 04:05:31 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 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
09/01/2023 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230901160215

FACILITY NAME:	SILVER OAKS		FACILITY NUMBER:	415601052
ADMINISTRATOR:	OLLIE VANCE		FACILITY TYPE:	740
ADDRESS:	16 COLEMAN PLACE		TELEPHONE:	(650) 322-2022
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY:	43	CENSUS:	DATE:	10/06/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Ollie Vance & Shayla Brewster		TIME COMPLETED:	10:25 AM

ALLEGATION(S):

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Staff mishandled a resident's medications while in care
Staff are not properly administering a resident's medications

INVESTIGATION FINDINGS:

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On 10/6/23, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegations. LPA met with Administrator, Ollie Vance & Resident Care Coordinator Shayla Brewster. LPA explained the purpose of the visit.

Regarding the allegation that staff mishandled a resident's medications while in care and staff are not properly administering a resident's medications, reporting party (RP) the facility's inability to accurately administer medications and their inability to refill medications in a timely manner is putting this pt at risk for further seizures and risk for injuries. During one of RPs visit, a supply that was dispensed on 08/10 should have only lasted through 08/31, but on 08/31, at least half of the bottle of Lacosamide solution was remaining. Based on the amount of medication remaining, RP suspected that R1 has only been getting half of the prescribed dose. R1 also has lorazepam routinely for seizure prevention. Staff reported that on 08/10/23 that they had run out of lorazepam several days before notifying and requested an urgent refill. They had ordered the medication by mail but it had not yet arrived.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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-20230901160215

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SILVER OAKS	FACILITY NUMBER: 415601052
	VISIT DATE: 10/06/2023

NARRATIVE

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LPA checked the medication cart and saw during this time that a bottle of the medication, Lacosamide, was halfway through based on the weight. This is the fourth bottle that the facility has opened. Based on records review, a delivery from the pharmacy stated three bottles of medication, each containing 200ml. During investigation, a fourth bottle was observed as opened, and this bottle was part of the delivery from another pharmacy which also sent three, each containing 200ml. The total bottles the facility received were 6 with 200ml each. Another medication, Lorazepam was mentioned to be ordered urgently. Facility has already placed order 7 days before the medication runs out but the pharmacy hasn’t delivered right away. Kaiser pharmacy does take around 7-10 days to fulfill an order. Facilities are only able to order refills if the medication has only 7 days left for use.

Based on records review, the calculations show that based on the remaining medications, the MAR, the resident was given the correct amount of dosage per the doctors order. Since the facility had enough bottles for the Lacosamide medication, they didn’t order until, they have opened the last bottle. Facility had enough bottle of Lacosamide and did not have to order until they have opened the last bottle.

Therefore, based on the interviews conducted, files reviewed, and information collected, the allegations above are UNFOUNDED, meaning that this allegation was false, could not have happened and/or is without a reasonable basis.

Report is reviewed and a copy is provided.

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC9099 (FAS) - (06/04)

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