197608180-11-5-2024-28-AS-LHIS-DB5NGJ-20241118092710

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608180
Report Date: 11/05/2024
Date Signed: 11/05/2024 03:41:56 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
10/30/2024 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241030153735

FACILITY NAME:	SILVERADO SENIOR LIVING - THE HUNTINGTON		FACILITY NUMBER:	197608180
ADMINISTRATOR:	ROCHELLE CARPIO		FACILITY TYPE:	740
ADDRESS:	1118 N STONEMAN AVE		TELEPHONE:	(626) 308-9777
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	62	CENSUS: 57	DATE:	11/05/2024
		UNANNOUNCED	TIME BEGAN:	11:13 AM
MET WITH:	Arrienne Ghammange, Director of Health Services		TIME COMPLETED:	03:52 PM

ALLEGATION(S):

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Facility staff are not ensuring resident's medication is being administered as prescribed
Facility staff do not intervene when resident's engage in physical altercations
Facility staff did not safeguard resident's personal items

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alberto Lopez made an unannounced visit to investigate the above allegations and met with Arrienne Ghammange. LPA discussed the purpose of the visit.

The investigation consisted of LPA reviewing and obtaining staff and resident roosters, interviewing four (4) staff and five (5) residents (R#2-R#6). R1 has moved out and not available for interview. LPA reviewed R1 file and medication list, Property/Clothing list of R1, Face sheet of R1, Medication list for R1, SIR dated 08/22/2024 regarding un-witnessed fall of R1. Release of liability arising from lost items signed by responsible party, e-MAR for R1 08/2024.

The investigation revealed:

Allegation: Facility staff are not ensuring resident's medication is being administered as prescribed. It is alleged that facility pressured R1 family members into giving anti-psychotic to R1. (Continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

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-20241030153735

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: 11/05/2024

NARRATIVE

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(Continued from 9099)
LPA interviewed four (4) staff and all four (4) staff denied the allegation. LPA interviewed five residents and all five (5) residents were not able to corroborated the allegations. R1 was admitted on 07/20/2024 and moved out on 08/18/2024. According to S3, R1 was prescribed an anti-psychotic for aggression and being combative. S3 stated S3 never personally administered the anti-psychotic due to her schedule. S1 stated that family is always consulted first and make the final decision for any new medication(s). Record reviewed showed that R1 physician ordered the anti-psychotic for agitation with start date of 08/16/2024 and was administered according to doctor's orders. There is no evidence that family was pressured into authorizing anti-psychotic for R1.

Allegation: Facility staff do not intervene when resident's engage in physical altercations. It is alleged that resident had an altercation with another residents and staff did not intervene. LPA interviewed four (4) staff and all four staff denied the allegation. S1 stated R1 was found on floor by staff on duty and SIR submitted to the department. LPA interviewed five (5) residents and five (5) of five (5) residents could not corroborate the allegation. All five (5) residents stated they have never witness resident on resident violence at facility. There is not evidence that staff allowed aggressive behavior between residents.

Allegation Facility staff did not safeguard resident's personal items. It is alleged that facility failed to safeguard resident's phone charger and is lost.

LPA interviewed four (4) staff and all four (4) staff denied the allegation. LPA interviewed five (5) residents and five (5) of five (5) residents could not corroborate any lost or stolen items. S2 stated S2 completes an inventory list when residents move in, Reviewed of R1 personal property showed no phone charger on the list. S2 stated the facility does everything they can to safeguard residents personal property but things do get separated from residents from time to time. There is not enough evidence to substantiate this allegation.

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

An exit interview was conducted with Arrienne Ghammange. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

LIC9099 (FAS) - (06/04)

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