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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 12/29/2023
Date Signed: 12/29/2023 01:02:02 PM

Unfounded


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
12/22/2023 and conducted by Evaluator Grace Donato
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20231222083757
FACILITY NAME:SILVER OAKSFACILITY NUMBER:
415601052
ADMINISTRATOR:OLLIE VANCEFACILITY TYPE:
740
ADDRESS:16 COLEMAN PLACETELEPHONE:
(650) 322-2022
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:43CENSUS: 36DATE:
12/29/2023
UNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Ollie Vance & Shayla BrewsterTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Staff did not ensure that changes in a resident's condition were brought to the attention of a physician.
INVESTIGATION FINDINGS:
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9
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12
13
On 12/29/2023, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegation. LPA met with Administrator, Ollie Vance and Resident Care Coordinator Shayla Brewster and explained the purpose of the visit.

Regarding the allegation of staff did not ensure that changes in a resident's condition were brought to the attention of a physician, RP stated that he/she is concerned because when he/she is at this facility, RP observes an older resident who seems to be in pain and in distress.

During the investigation, LPA reviewed records that show correspondence between resident care coordinator and admininstrator and physician. Records also show how physician addressed the adjustment of medication for the resident.

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: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace DonatoTELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023
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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