415601052-11-6-2023-14-AS-JJIN-CYBQC4-20231208110228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 09/01/2023
Date Signed: 11/06/2023 06:27:58 PM

Unsubstantiated

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
08/15/2023 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230815111613

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:	09/01/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Ollie Vance & Shayla Brewster		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff do not ensure that residents' bathing needs are met while in care.
Facility is dirty.
Staff are not ensuring that resident's are administered medication(s) according to physician's instructions.

INVESTIGATION FINDINGS:

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This is an amended report.

On 09/01/23, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced 10-day complaint inspection. LPA met with Resident Care Coordinator Shayla Brewster and Administrator Ollie Vance followed. LPA explained the purpose of the visit.

Regarding the allegation that staff do not ensure that residents' bathing needs are met while in care, according to reporting party there is no indication that residents are being cleaned by staff because they stopped providing hospice agency stopped bathing resident because facility didn’t give medication for aggressive behavior.

LPA observed residents while having breakfast and everyone was well groomed and clean. LPA also toured a random sample of resident’s rooms, and all were observed to be clean and doing their own activities or resting in bed.

Unsubstantiated

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: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

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-20230815111613

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: 09/01/2023

NARRATIVE

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Based on record reviews, ADLs log indicated logs where residents had either bed baths or showers. Logs did not indicate any residents missing their bathing schedule. LPA checked the facility’s linen closet and has sufficient towels and linens for residents to use, otherwise it is provided by family members as indicated in the admission agreement packet.

Regarding the allegation of facility is dirty, RP mentioned that the bathrooms & showers are filthy.

Upon arriving, LPA requested a tour around the facility. LPA observed housekeeping vacuuming rooms and cleaning the bathrooms while residents are having their breakfast in the dining hall. All bathrooms, including private bathrooms, were checked and everything is in order and clean. LPA reviewed housekeeping logs for the month of August and it showed that the bathrooms were cleaned a total of 93 times. It also showed that it is cleaned three times a day.

Based on an interview with administrator, facility housekeeping cleans the facility all throughout the day. Family members have no concern about the cleanliness of the facility. They feel that the facility is clean. Whenever they visit, they don’t see any issue with regards to cleanliness.

Regarding the allegation that staff are not ensuring that residents are administered medication(s) according to physician's instructions, RP mentioned that whenever PRN medication is requested to be administered, staff forgets and gives excuses for not being able to give medication.

Based on record reviews, all medication administration, including PRNs, has been logged. The request of RP was followed, and records show that the medication was given to the resident. Staff were interviewed about their medication procedure. Medication arrives and staff must centrally store it. There are about 7 med passes happening throughout the day. If in any case a staff forgets to give medication, then an incident report will be filed after facility contacts PCP.

Therefore, based on the interviews conducted, files reviewed, and information collected, the above allegations are found to be 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 is reviewed and copy is provided.

SUPERVISOR'S NAME: April Cowan	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

LIC9099 (FAS) - (06/04)

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