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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600869
Report Date: 08/18/2023
Date Signed: 08/18/2023 03:05:32 PM


Document Has Been Signed on 08/18/2023 03:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:SILVERADO SENIOR LIVING - BELMONT HILLSFACILITY NUMBER:
415600869
ADMINISTRATOR:ROBERT SNEEFACILITY TYPE:
740
ADDRESS:1301 RALSTON AVETELEPHONE:
(650) 654-9700
CITY:BELMONTSTATE: CAZIP CODE:
94002
CAPACITY:112CENSUS: 69DATE:
08/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Robert SneeTIME COMPLETED:
03:15 PM
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On August 18, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit to follow up on an incident that was reported to CCLD on 8/17/2023. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero and explained the purpose of the visit.

The Licensee reported on 8/10/2023, Resident 1 (R1) was bitten by a dog. Blood was noted on right middle finger, however R1 denied pain.

During the visit, LPA interviewed the administrator, requested copies of the dog's vaccination records, reviewed facility policies and procedures regarding pets, observed blank facility admission agreement and reviewed a copy of resident handbook regarding pets at the facility.

According to the administrator and director of health services, there were no prior biting incidents at the facility with this specific dog. The dog was returned back to the adoption center after the incident.

LPA reviewed resident handbook and policies and procedures regarding pets at the community. Based on the resident handbook reviewed, it indicated that the community has pets to promote resident's quality of life. In addition, the facility handbook also indicates that residents are welcome to bring their pets as well. Furthermore, LPA reviewed the dog's vaccination record and all shots are up to date.

No deficiencies cited during the visit. Report is reviewed with Director of Health Services and Administrator and a copy is provided.
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal CharitraTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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