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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608180
Report Date: 01/04/2024
Date Signed: 01/04/2024 02:14:29 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
10/30/2023 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231030143019
FACILITY NAME:SILVERADO SENIOR LIVING - THE HUNTINGTONFACILITY NUMBER:
197608180
ADMINISTRATOR:ROCHELLE CARPIOFACILITY TYPE:
740
ADDRESS:1118 N STONEMAN AVETELEPHONE:
(626) 308-9777
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:62CENSUS: 51DATE:
01/04/2024
UNANNOUNCEDTIME BEGAN:
09:51 AM
MET WITH:Arrienne GhammangeTIME COMPLETED:
02:16 PM
ALLEGATION(S):
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Lack of supervision resulting in unsafe environment for residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez conducted a subsequent visit to investigate the allegation listed above. LPA was greeted by Elizabeth Cruzes, Receptionist and LPA discussed the purpose of the visit. LPA met with Staff Arienne Ghammange who assisted with the visit.

The investigation consisted of LPA taking a tour of facility, interviewing nine staff including Administrator S#1-S#9 (S1-S9) and 5 residents R#1 - R#5 (R1-R5), three witnesses W#1-W#3 (W1-W3) reviewing and obtaining copies of R1, R2 and R3 Physicians Report and other pertinent information.

The investigation revealed:

(Continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 28-AS-20231030143019
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SILVERADO SENIOR LIVING - THE HUNTINGTON
FACILITY NUMBER: 197608180
VISIT DATE: 01/04/2024
NARRATIVE
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The investigation revealed:

Allegation: Lack of supervision resulting in unsafe environment for residents. It is alleged that a resident threw a ceramic plate and it shattered into pieces that could have harmed the residents. R#1 stated she witness the incident and that the maintenance man came in and swept it up right away. R#1 stated she grabbed a broken piece of the cup (for evidence) and took it to her room. S5 stated she went to sweep it up it up, but it was already cleaned up by another staff by the time she got there and just ran a mop over it. No resident was ever in harm’s way during entire incident. No resident was harmed. Residents interviewed could not collaborate the allegation. R1 was asked to return the broken piece more than once to discard it and refused to hand it over. She finally did hand it over to police who discarded the piece and left without investigating. There is no evidence that lack of supervision is making it unsafe for residents. Therefore, this allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
10/30/2023 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231030143019

FACILITY NAME:SILVERADO SENIOR LIVING - THE HUNTINGTONFACILITY NUMBER:
197608180
ADMINISTRATOR:ROCHELLE CARPIOFACILITY TYPE:
740
ADDRESS:1118 N STONEMAN AVETELEPHONE:
(626) 308-9777
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:62CENSUS: 51DATE:
01/04/2024
UNANNOUNCEDTIME BEGAN:
09:51 AM
MET WITH:Arrienne GhammangeTIME COMPLETED:
02:16 PM
ALLEGATION(S):
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Resident denied the right to visit the facility prior to residence.
INVESTIGATION FINDINGS:
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Allegation: Resident denied the right to visit facility prior to residence. It is alleged that resident did not visit the facility prior to admission and had no choice in the matter. Administrator S1 stated that it was her POA (Son) W1 who made the decision to transfer resident to current facility due to being closer to his place of employment. R1 was climbing the fence at previous facility in Sierra Vista, and it was recommended by staff there to transfer her to sister facility in Alhambra. All staff denied that residents was tricked into coming to facility as POA (son) had made the decision on her behalf. W1 (POA/SON) stated he was fine with the recommendation to transfer R1 and did not feel he needed to visit the new place. W1 stated his concerns were addressed prior to transfer. It was an emergency transfer to make sure resident was safe.POA stated they checked out the facility after the transfer. W1 stated the facility never offered for him or resident to visit or tour facility prior to the transfer. It is the responsibility of the facility to insure that resident/family or authorized representative tour/visit facility prior to admission. Based on LPA's observations and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20231030143019
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SILVERADO SENIOR LIVING - THE HUNTINGTON
FACILITY NUMBER: 197608180
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2024
Section Cited
CCR
80072(a)(b)(1)
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80072(a)(b)(1) (a) In addition to Section 80072, the following shall apply.

(b) The licensee shall insure that each client is accorded the following personal rights.

(1) To visit the facility with his/her relatives or authorized representative prior to admission.
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Administrator will send written plan on how they will avoid this in the future and train admitting staff to insure that residents are accorded all personal rights and send sign roster of staff who attended the training by POC date.
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Facility failed to insure that resident/family or authorized representative visit facility prior to admission.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4