415601052-11-6-2023-14-AS-KHOS-CY2NG4-20231129092631

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 10/25/2023
Date Signed: 11/06/2023 06:25:19 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
10/20/2023 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20231020143805

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: 35	DATE:	10/25/2023
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Ollie Vance & Shayla Brewster		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff speaks inappropriately to residents in care.

INVESTIGATION FINDINGS:

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Amended Report
On 10/25/2023, Licensing Program Analyst (LPA) Grace Donato an unannounced 10-day complaint inspection.. LPA met with Resident Care Director, Shayla Brewster and explained the purpose of the visit.

Regarding the allegation that staff speaks inappropriately to residents. Reporting party (RP) mentioned that residents are spoken too with inapproriate language by a staff member (S1).

Based on staff interviews, four out of four mentioned that they haven't heard anything or seen anything where S1 was talking to a resident inappropriately, they also cannot confirm that these incidents happened. S1 was also interviewed and could't recall any incident where a resident was spoken to inapproriately.

LPA also interviewed two residents. One mentioned that they haven't heard anything about S1 not helping or shouting at residents. Another mentioned that S1 always help with whatever they need or request. Both residents like living here and feels that they are well taken care of.

Based on the above information, the Department has found that this allegation to be UNFOUNDED, meaning that this allegation was false, could not have happened and/or is without a reasonable basis.

Report was discussed with Administrator and a copy of this report is provided.

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: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

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-20231020143805

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: 10/25/2023

NARRATIVE

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LPA also interviewed two residents. One mentioned that they haven't heard anything about S1 not helping or shouting at residents. Another mentioned that S1 always help with whatever they need or request. Both residents like living here and feels that they are well taken care of.

Based on the above information, the Department has found that this allegation to be UNFOUNDED, meaning that this allegation was false, could not have happened and/or is without a reasonable basis.

Report was discussed with Administrator and a copy of this report is provided.

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

LIC9099 (FAS) - (06/04)

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