197608180-8-3-2021-28-AS-LHIS-C74TY2-20210922150800

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608180
Report Date: 08/03/2021
Date Signed: 08/03/2021 05:42:41 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
07/27/2021 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210727094858

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: 30	DATE:	08/03/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Safoora Ahmed, Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff are not preventing the spread of an outbreak.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with Jean Bonnette, Director of Resident and Family Services and explained the purpose of the visit. Administrator, Safoora Ahmed, arrived to assist shortly thereafter.

During today’s visit, LPA Chan toured the facility with the Director of Family Services. LPA interviewed the Administrator, 6 Staff, and 3 Residents. LPA obtained a copy of the staff roster, resident roster, COVID-19 Mtigation Plan, and Staff In-Service training log.

Regarding allegation – Staff are not preventing the spread of an outbreak, alleging that staff do not wear masks at the facility. Due to the Covid-19 (Coronavirus) pandemic, the facility is taking precautions to mitigate or prevent from getting infected with the virus.

Substantiated

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: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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-20210727094858

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: 08/03/2021

NARRATIVE

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Per interviews conducted with the Administrator and Staff, they all have received training on COVID-19 and on properly donning and doffing the PPEs. They also stated that the Administrator will remind staff the importance of wearing their masks regularly. The Administrator and the Director of Health Services are the ones who provide ongoing in-services to educate and update staff on COVID-19. LPA obtained the sign-in log on Aerosol Transmissible Disease and PPE/Respiratory Protocol which was held in April 2021. In addition, the Administrator stated that staff also receives updates on COVID-19 during staff meetings which are held once a month.

During today’s visit, LPA observed all staff wearing a mask properly. LPA interviewed 6 Staff and all stated that masks are required at the facility. 5 out of 6 stated staff wear their masks at all times in the facility, except when they are eating. One stated that staff were seen without a mask sometimes and had to remind them. Only 1 out of 3 residents interviewed stated the staff was not seen wearing a mask at times. Administrator Ahmed also disclosed that a staff was counseled sometime last week for forgetting to wear a mask while assisting a resident in the room. The resident’s family member also witnessed staff not wearing a mask.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 8), are being cited on the attached LIC 9099D.

An exit interview was conducted. A copy of this report, Plan of Correction, and Appeal Rights were provided to the LVN.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210727094858

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/03/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/10/2021 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator shall conducted another in-service training to all staff on PPE and provide information on updated COVID-19 protocols. The in-service log shall be submitted to LPA by due date 8/10/21.
	8 9 10 11 12 13 14	The licensee did not ensure that the staff member was wearing a mask while assisting resident which poses a potential health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

LIC9099 (FAS) - (06/04)

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