415601052-3-27-2023-14-AS-KHOS-CQRKQV-20230410080658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 03/27/2023
Date Signed: 03/27/2023 11:13:52 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 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
02/14/2023 and conducted by Evaluator Komal Charitra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230214104501

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: 34	DATE:	03/27/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Administrator, Ollie Vance		TIME COMPLETED:	11:24 AM

ALLEGATION(S):

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Staff are forcing Covid-19 free residents to isolate in their rooms.
Staff are not providing activities for residents in care.

INVESTIGATION FINDINGS:

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On March 27, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Administrator, Ollie Vance and explained the purpose of the visit.

Regarding the allegation that staff are forcing COVID-19 free residents to isolate in their rooms, according to the reporting party, staff are making COVID negative residents isolate in their rooms and allowing COVID positive residents wander around the facility.

The administrator denied this allegation. According to the administrator, COVID negative residents were able to leave their rooms, watch television in the communal living room area, eat in the dining room, and continue with their daily routines as usual. In addition, interviewed staff indicated that COVID positive residents were isolated in their rooms, however due to their dementia, some residents wanted to wander around the facility but staff ensured to redirect residents back to their rooms, provide the residents with face masks and keep them away from the COVID negative residents. (CONT. TO 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal Charitra	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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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Control Number 14-AS-20230214104501

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SILVER OAKS	FACILITY NUMBER: 415601052
	VISIT DATE: 03/27/2023

NARRATIVE

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Regarding the allegation that staff are not providing activities for residents in care, according to the reporting party, staff stopped all activities for residents and the Activities Director was not allowed to come into the facility. During the investigation, LPA interviewed the administrator and the staff that provided activities for the COVID positive and negative residents.

The administrator denied this allegation and indicated that the Activities Director went into each of the COVID positive residents' rooms in full PPE and provided them with activities; bingo, coloring, music, etc. for about thirty minutes to an hour everyday. In addition, the administrator stated that the Activities Director provided activities; bingo, karaoke, dancing, coloring, music, etc. for the COVID negative residents in the activities room. According to the Activities Director, she tried her best to ensure that the COVID positive residents who wandered the facility and wanted to do activities with the COVID negative residents had a face mask and stayed 6ft away from the COVID negative residents. Interviewed staff indicated when the Activities Director tested positive for COVID, the Caregivers took over and provided the activities for both the COVID positive and COVID negative residents throughout their shifts.

Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations above are UNSUBSTANTIATED.

Report is reviewed with Administrator, Ollie Vance and a copy is provided.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal Charitra	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC9099 (FAS) - (06/04)

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