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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200938
Report Date: 03/05/2025
Date Signed: 03/05/2025 03:51:29 PM

Document Has Been Signed on 03/05/2025 03:51 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:SILVERADO SENIOR LIVING-BERKELEYFACILITY NUMBER:
019200938
ADMINISTRATOR/
DIRECTOR:
EMORUWA, JEFFREY OFACILITY TYPE:
740
ADDRESS:2235 SACRAMENTO STREETTELEPHONE:
(949) 240-7200
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY: 90CENSUS: 76DATE:
03/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Jeffrey Emoruwa, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 03/05/25 around 10:00 AM L. Holmes, Licensing Program Analyst (LPA) arrived unannounced to conduct a case management regarding two (2) Unusual Incident Reports (UIRs). LPA was greeted by the Receptionist and explained the purpose of the visit while Jeffrey Emoruwa, Administrator (ADM) attended a meeting. ADM arrived about ten (10) minutes later.

On 02/21/25, LPA received an email from ADM reporting 2 staff made physical contact with 2 residents on 2 different occasions. The facility became aware of the incidents evening on 02/19/25, and the investigation is still in progress. Staff (S1, S2) were suspended on 02/19/25 pending the results of the investigation; residents involved were (R1, R2).

S4 alleged that S1 made contact to R1's left cheek while trying to stop R1 from be being agitated, throwing glass and trying to hit at S1. S4 stated that the incident happened in the dining area about a month ago (01/2025)

S3 alleged that S2 slapped R2's forearm in an effort to prevent R2 from placing his/her hands inside their own briefs. S3 stated that the incident occurred about 2 months ago (12/2024) in R2's bedroom.

Human Resources conducted a one (1) day investigation on site, and 1 day of calling for interviews; four (4) additional caregivers and 2 nurses were assigned to the facility to assist.

W1 interviewed ADM also. S1 resigned prior to completion of the investigation. At this time, the facility's investigation is inconclusive.

Exit interview conducted and a copy of this report provided to Jeffrey Emoruwa, Administrator.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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