415601052-8-13-2025-14-AS-ACON-DLKUXE-20250916155813

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 08/13/2025
Date Signed: 08/13/2025 09:49:15 AM

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
07/03/2025 and conducted by Evaluator Komal Charitra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20250703082904

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: 39	DATE:	08/13/2025
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Dietary Supervisor, Francis Macahilas		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not seek timely medical care for resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On August 13, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the findings for the above allegation. LPA met with Dietary Supervisor, Francis Macahilas and explained the purpose of the visit.

Regarding the allegation, staff did seek timely medical care for resident, according to the reporting party, the facility failed to call the after-hour supportive care service during the weekend to report Resident 1's (R1's) symptoms, but rather faxed 3 reports to the physician's office (fax reports were not provided when requested by LPA) that is only open during regular business hours. In addition, the reporting party indicated on June 30, 2025, chest x-rays were ordered for R1, however on July 1, 2025, it was indicated by the third party radiology company that on 6/30/25 in the evening, the technician went out to do the x-ray but was told by facility staff that there is no resident by R1's name so the technician left and R1 didn't get his/her x-ray which caused a delay in treatment and potential complications and poor outcomes.

During the investigation, LPA reviewed staff schedule, interviewed administrator, staff, reviewed documents and interviewed the third party radiology company. (continue to 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 14-AS-20250703082904

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: 08/13/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on the third party radiology company interviewed, they never went to the facility on 6/30/25. The third party radiology company called the facility on 6/30/25 to schedule an appointment for 7/1/25, however were told by facility staff that R1 no longer resided at the facility. Radiology company called the physician's office to confirm and eventually did go out to the facility and do chest x-rays for R1 on 7/1/25.

Based on documents reviewed, it was observed that the facility only faxed the physician's office on 6/29/25 and called the after-hour supportive care service number on 7/1/25 and received confirmation from the physician's office indicating that the fax was received. According to the administrator, the med-techs only have access to the phones so if someone called to schedule an appointment for a resident, the med-techs and/or the directors would be aware of it. Based on interviews with the med-techs that were on shift 6/30/25 and 7/1/25, it was indicated that no agency called to schedule an appointment for R1 and that all med-techs are aware of R1 and who he/she is. In addition, they indicated that only med-techs have access to the phone so if someone did call to schedule an appointment for R1, they would be aware.

Therefore, based on interviews conducted and record reviewed, 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 above allegations are UNSUBSTANTIATED.

Report is reviewed with the Dietary Supervisor, Francis Macahilas and a copy is provided.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2