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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 12/26/2024
Date Signed: 12/26/2024 12:55:27 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
12/19/2024 and conducted by Evaluator Komal Charitra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20241219154758
FACILITY NAME:SILVER OAKSFACILITY NUMBER:
415601052
ADMINISTRATOR:JOSHUA LAMBENGCOFACILITY TYPE:
740
ADDRESS:16 COLEMAN PLACETELEPHONE:
(650) 322-2022
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:43CENSUS: 41DATE:
12/26/2024
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Administrator, Joshua LambengcoTIME COMPLETED:
01:10 PM
ALLEGATION(S):
1
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9
Staff did not re-order residents medication timely causing the resident to have seizures
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
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12
13
On December 26, 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 did not re-order residents medication timely causing the resident to have seizures, according to the reporting party, on 12/19/24, Resident 1 (R1) had a seizure in the morning and another seizure at 1pm. In addition, the reporting party stated, the facility reordered lorazepam earlier in the week for R1 which is supposed to be given three times a day for seizure prevention, however it was stated that the facility did not notify the provider when they ran out of lorazepam and R1 received the last dose of lorazepam in the morning on 12/18/24 which caused R1 to have multiple seizures 24 hours later.

During the investigation, LPA reviewed R1’s physician’s report, medication list, and medication administrative records (MAR). Based on the medication list and physician’s orders, R1 is required to take 1 tablet of lorazepam by mouth 3 times a day to prevent seizures. LPA reviewed R1’s MAR and observed R1 received all three doses on 12/18/24. According to the administrator and med-tech interviewed, the facility reordered R1’s medication on 12/18/24 after giving the three doses to R1. In addition, based on interviews and the MAR review, on 12/19/24, R1 did not receive his/her morning dose because R1 went to the hospital. While R1 was out at the hospital the refill for Lorazepam came in at 3pm on 12/19/24

Therefore, based on interviews conducted, record review and information collected, the department has determined that although the above allegation 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 allegation, staff did not re-order residents medication timely causing the resident to have seizures is UNSUBSTANTIATED.

Report is reviewed with the administrator and a copy is provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
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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