197608180-4-6-2021-28-AS-MVAO-C23NS5-20210414104235

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608180
Report Date: 04/06/2021
Date Signed: 04/06/2021 04:39:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/30/2020 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201230082345

FACILITY NAME:	SILVERADO SENIOR LIVING - THE HUNTINGTON		FACILITY NUMBER:	197608180
ADMINISTRATOR:	SAFOORA AHMED		FACILITY TYPE:	740
ADDRESS:	1118 N STONEMAN AVE		TELEPHONE:	(626) 308-9777
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	62	CENSUS: 27	DATE:	04/06/2021
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Safoora Ahmed, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident being denied services.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver the finding for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Safoora Ahmed, the facility Administrator.

On the initial visit dated 1/7/21, LPA Chan conducted telephone interviews with Tana McMillon, Regional Vice President of Operations, and Jesica Posada, the Director of Engagement. The LPA also requested copies of the staff and resident rosters, Plan of Operation policy on private caregivers, and documents pertaining to Resident #1 (R1).

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2021

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 28-AS-20201230082345

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SILVERADO SENIOR LIVING - THE HUNTINGTON	FACILITY NUMBER: 197608180
	VISIT DATE: 04/06/2021

NARRATIVE

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Investigation revealed the following. Regarding allegation, resident being denied services. During the initial investigation on 1/7/21, Tana McMillon, the Regional Vice President of Operations, was handling this matter while the Administrator was on a leave of absence. Based on the interview with Tana, Resident #1’s family member had requested one-on-one private caregivers to monitor resident on a daily basis. She informed the family member that she needed to check on the protocols prior to determining access. In addition, Tana stated that she was taking proper precaution to ensure the safety of all individuals as well as the private caregivers, given that the facility was experiencing an outbreak of the Coronavirus. She was in communication with different agencies to determine the current guidance pertaining to visitation and whether criminal background clearances were required for these private caregivers. LPA verified with Marlene Pun from Los Angeles Department of Public Health that Mrs. McMillon had requested approval for the private caregivers to be permitted in the facility. Mrs. McMillon had also reached out to LPA Chan on 1/5/21 to inquire about the criminal background clearances. On 1/6/21, Mrs. McMillon granted the family caregivers to enter the facility to monitor Resident #1. Based on information obtained, the facility was taking steps to ensure regulations and guidelines are being followed, prior to granting the private caregivers access to the community.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A telephonic exit interview was conducted with the Administrator and a hard copy was provided via email for signature. The Appeal Rights were also provided with this report.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2021

LIC9099 (FAS) - (06/04)

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