We report carboxy-terminated silicon quantum dots (SiQDs) that exhibit high solubility in water due to the high molecular coverage of surface monolayers, bright light emission with high photoluminescence quantum yields (PLQYs), long-term stability in the PL property for monitoring cells, less toxicity to the cells, and a high photothermal response. We prepared water-soluble SiQDs by the thermal hydrosilylation of 10-undecenoic acid on their hydrogen-terminated surfaces, provided by the thermal disproportionation of triethoxysilane hydrolyzed at pH 3 and subsequent hydrofluoric etching. The 10-undecanoic acid-functionalized SiQDs (UA:SiQDs) showed long-term stability in hydrophilic solvents including ethanol and water (pH 7). We assess their interaction with live cells by means of cellular uptake, short-term toxicity, and, for the first time, long-term cytotoxicity. Results show that UA:SiQDs are potential candidates for theranostics, with their good optical properties enabling imaging for more than 18 days and a photothermal response having a 25.1% photothermal conversion efficiency together with the direct evidence of cell death by laser irradiation. UA:SiQDs have low cytotoxicity with full viability of up to 400 μg/mL for the short term and a 50% cell viability value after 14 days of incubation at a 50 μg/mL concentration.