415601052-10-22-2024-14-AS-KHOS-DAQNN5-20241105093609

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 10/22/2024
Date Signed: 10/22/2024 02:04:24 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
10/16/2024 and conducted by Evaluator Komal Charitra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20241016092524

FACILITY NAME:	SILVER OAKS		FACILITY NUMBER:	415601052
ADMINISTRATOR:	JOSHUA LAMBENGCO		FACILITY TYPE:	740
ADDRESS:	16 COLEMAN PLACE		TELEPHONE:	(650) 322-2022
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY:	43	CENSUS: 38	DATE:	10/22/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Joshua Lambengco		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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-Staff do not ensure residents have incontinence supplies
-Staff did not follow protocals to prevent the spread of COVID
-Staff do not meet resident needs

INVESTIGATION FINDINGS:

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On October 22, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced 10-day complaint visit. LPA met with Administrator, Joshua Lambengco and explained the purpose of the visit.

Regarding the allegation, staff do not ensure residents have incontinence supplies, according to the reporting party, facility does not provide enough incontinence supplies to residents. During the investigation, LPA observed the facility's supplies closet and observed a sufficient amount of incontinence supplies. In addition, according to the administrator and staff interviewed, the Clinical Director and Med-techs conduct an audit of the supply room every week and puts an order in to to get supplies delivered once a week to the facility.

Regarding the allegation, staff did not follow protocols to prevent the spread of COVID, according to the reporting party, there was a COVID outbreak in September and the facility did not follow county protocols. During the investigation, LPA interviewed the administrator and 5 staff members. According to the administrator, there were only 3 residents that tested positive for COVID at the facility. Based on 6/6 staff interviews conducted, including the administrator, it was stated that the facility ensured the COVID positive residents were isolated in a single private room with PPE carts outside the room and tried to enforce masking for all residents even if residents tried to take their masks off. (Cont. to 9099C).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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-20241016092524

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SILVER OAKS	FACILITY NUMBER: 415601052
	VISIT DATE: 10/22/2024

NARRATIVE

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In addition, staff interviewed indicated that COVID positive residents would be provided meals in their rooms and if they did wander in the facility, staff would redirect them back to their room. During the time of the COVID outbreak, the administrator indicated that all staff members were required to wear masks and high touched surfaces were being cleaned once or twice a shift. Based on documentation reviewed, the facility followed their COVID-19 mitigation plan.

Regarding the allegation, staff do not meet resident needs, according to the reporting party, facility does not have enough staff on the floor, as there was one day with only 2 caregivers for 40 residents and during the night, there is only one caregiver. During the investigation, LPA observed 5 caregivers present at the facility and 1 med-tech. According to the administrator and the sales director, the facility is fully staffed and there has not been any issues with staffing. In addition, according to 4/5 staff members interviewed, there is no issues with staffing at the facility, and they believe that they are able to manage with the amount of caregivers there are. Furthermore, the administrator and 4/5 staff interviewed indicated that there are 4-5 caregivers and 1 med-tech during the AM shift, 4-5 caregivers and 1 med-tech during the PM shift, and 2 caregivers and 1 med-tech during NOC shift.

Therefore, based on interviews conducted, information collected and observations, the department has determined that although the above allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations, staff do not ensure residents have incontinence supplies, staff did not follow protocols to prevent the spread of COVID, and staff do not meet resident needs is UNSUBSTANTIATED.

Report is reviewed with the administrator and a copy is provided.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC9099 (FAS) - (06/04)

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