415601052-1-11-2024-14-AS-KHOS-D26KPK-20240205070452

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 01/11/2024
Date Signed: 01/11/2024 06:27:31 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
01/04/2024 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20240104100544

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: 37	DATE:	01/11/2024
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Ollie Vance & Shayla Brewster		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not providing resident's authorized representative with a refund

INVESTIGATION FINDINGS:

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On 1/11/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Administrator, Ollie Vance and Resident Care Coordinator Shayla Brewster and explained the purpose of the visit.

Regarding the allegation of Staff are not providing resident's authorized representative with a refund, reporting party (RP) stated that he/she has sent emails and made multiple calls to the finance person (S1) and there is no response if there is a refund.

LPA interviewed RP and confirmed that there has been emails sent to S1 and that no response was provided. LPA also interviewed the Administrator and it was mentioned that S1 was on vacation during this time. Administrator wasn't aware of the email but was reviewing the refund around this time. Facility had to review the initial refund as RP overpaid by a month. Facility wanted to give the correct amount. A check has already been sent out.

Therefore, based on the interviews conducted, files reviewed, and information collected, the allegation mentioned is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

The report was reviewed, and a copy is provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: April Cowan	TELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

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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