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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 04/30/2026
Date Signed: 04/30/2026 02:14:20 PM

Substantiated


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
03/24/2026 and conducted by Evaluator Komal Curley
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20260324084907
FACILITY NAME:SILVER OAKSFACILITY NUMBER:
415601052
ADMINISTRATOR:RILEY TUCKERFACILITY TYPE:
740
ADDRESS:16 COLEMAN PLACETELEPHONE:
(650) 322-2022
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:43CENSUS: 38DATE:
04/30/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Acting Administrator, Nick CatalanoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not provide resident's records to authorized representative
INVESTIGATION FINDINGS:
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On April 30, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegation. LPA met with Acting Administrator, Nick Catalano and explained the purpose of the visit.

Regarding the allegation, staff did not provide resident's records to authorized representative, according to the reporting party, Resident 1's (R1's) responsible party/power of attorney (POA) requested documents in relation to R1, however the facility denied access.

During the investigation, LPA interviewed the acting administrator. According to the acting administrator, he was not aware what he could send R1's responsible party/POA, however he did provide most of the requested documents to R1's responsible party/POA, In addition, he indicated that the facility's policy in regards to releasing resident records is to go through the management company's medical records.

Based on interviews conducted and information collected during the investigation, the preponderance of evidence standard has been met. Therefore, this allegation is determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Report was discussed with Acting Administrator, and Appeal Rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
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 4
Control Number 14-AS-20260324084907
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/07/2026
Section Cited
CCR
87506(c)(1)
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87506 Resident Records: (c) All information and records obtained from or regarding residents shall be confidential.
(1) The licensee shall be responsible for storing active...records and for safeguarding the confidentiality of their contents. The licensee... shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.
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Licensee/administrator to send LPA confirmation that documents requested by R1's responsible party/POA has been provided.
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This regulation is not met as evidenced by: According to the acting administrator, he was not aware what he could send R1's responsible party/POA, In addition, he indicated that the facility's policy in regards to releasing resident records is to go through the management company's medical records.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4
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
03/24/2026 and conducted by Evaluator Komal Curley
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20260324084907

FACILITY NAME:SILVER OAKSFACILITY NUMBER:
415601052
ADMINISTRATOR:RILEY TUCKERFACILITY TYPE:
740
ADDRESS:16 COLEMAN PLACETELEPHONE:
(650) 322-2022
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY:43CENSUS: 38DATE:
04/30/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Acting Administrator, Nick CatalanoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff did not follow residents care plan
Due to lack of supervision, resident fell resulting in injury
INVESTIGATION FINDINGS:
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On April 30, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Acting Administrator, Nick Catalano and explained the purpose of the visit.

Regarding the allegation, staff did not follow residents care plan, according to the reporting party, Resident 1 (R1) was a one-assist resident with dementia and should not have been left unattended. According to the reporting party, due to this lack of supervision, R1 wandered, became disoriented, entered a bathroom, and fell, resulting in injury.

During the investigation, LPA reviewed R1's care plan, interviewed staff and attempted to interview R1. LPA was unable to interview R1 due to his/her dementia diagnosis. Based on R1's service plan, R1 is minimum assist with mobility and can ambulate himself/herself with walker. Staff assist with escorting as needed. According to staff interviewed, R1 is not a two-persons assist, however staff do assist with ADLS. Staff indicated, R1 can ambulate himself/herself with a walker. (continue to 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 14-AS-20260324084907
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: 04/30/2026
NARRATIVE
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Staff 1 (S1) interviewed indicated he/she changed R1's briefs and while S1 was cleaning, R1 used his/her walker to leave the room and walked to the bathroom. After S1 was done cleaning, he/she did not observe R1 in the hallway so immediately checked the room next door and the bathroom across the hall and found R1 in the bathroom between the wall and commode slipping. S1 indicated he/she did observe R1 slip. Resident Care Coordinator and the med-tech on shift assessed R1 after the fall and called 911.

Therefore, based on interviews conducted and record reviewed, 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 above allegations are UNSUBSTANTIATED. Report is reviewed with Acting Administrator and a copy is provided.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4