415601052-7-17-2023-14-AS-CSMH-CUJPVM-20230809113922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601052
Report Date: 07/17/2023
Date Signed: 07/17/2023 03:35:00 PM

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
07/11/2023 and conducted by Evaluator Grace Donato

COMPLAINT CONTROL NUMBER: 14-AS-20230711124713

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: 35	DATE:	07/17/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Shayla Brewster		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff are unable to effectively communicate with residents in care.

INVESTIGATION FINDINGS:

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On 7/17/2023, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint inspection. LPA Donato met with Resident Care Director, Shayla Brewster. LPA Donato explained the purpose of the visit.

Regarding the allegation of staff are unable to effectively communicate with residents in care.

As part of the investigation, LPA interviewed 6 staff members and attempted to interview 3 residents. It was observed that residents were having an activity in the activity are and are being prepped for snacks. Residents were reluctant in answering questions and wanted to do the activity.

All staff members that were interviewed mentioned that any form of incident that happens to residents, they must report it right away to the med techs or the administrator. They are given walkies once they start work. These walkies assist them into calling for help when needed. Per protocol, med techs needed to be called because they are the ones who need to do assessment on the residents. There is always someone scheduled every shift and in cases of call outs there would be someone to cover.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

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-20230711124713

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: 07/17/2023

NARRATIVE

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All staff members doesn’t recall any incident where care wasn’t immediately given to residents. Even with caregivers who can’t speak English, they don’t have issues regarding communicating with the residents. As mentioned during interviews, if residents feel anything like pain, residents point on which part they feel the pain and caregivers address it right away. Caregivers are always on alert even when the residents are sitting down. They are always on the look out for cues on what that residents need or want at that time.

After the investigation, this allegation is deemed to be unsubstantiated because the incident in question, based interviews, didn’t happen as everyone follows a specific protocol on how to take care of residents when incidents like falls happen.

Although the 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 allegation is UNSUBSTANTIATED.

This report is reviewed and discussed with resident care director.
A copy is provided.

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

LIC9099 (FAS) - (06/04)

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