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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608180
Report Date: 02/25/2025
Date Signed: 02/25/2025 05:02:11 PM

Document Has Been Signed on 02/25/2025 05:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HUNTINGTONFACILITY NUMBER:
197608180
ADMINISTRATOR/
DIRECTOR:		ROCHELLE CARPIOFACILITY TYPE:
740
ADDRESS:1118 N STONEMAN AVETELEPHONE:
(626) 308-9777
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY: 62CENSUS: DATE:
02/25/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:25 PM
MET WITH:Rochelle Carpio AdminstratorTIME VISIT/
INSPECTION COMPLETED:
05:03 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Alberto Lopez and Sakinah Madyun conducted a subsequent visit to investigate two complaints. LPAs arrived unannounced and met with Arienne Ghammangne Director of Health Services and Rochelle Carpio Administrator arrived a short time later and assisted with the visit. The purpose of the visit was explained.

During a tour of facility at 9:50am with Arienne Ghammangne, Director of Health Services, LPAs observed the wellness room door unlocked on the second floor across from the elevator and dining area. Inside the room were three (3) pairs of sharp scissors in the unlocked room which are accessible to 32 residents in dementia care facility. This possess as an immediate risk to the health, safety, or personal rights of the persons in care.

Deficiency cited on 809D, exit interviewed conducted with Rochelle Carpio Administrator and copy of report and appeal rights provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/25/2025 05:02 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Alberto Lopez On 02/25/2025 at 03:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 02/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
02/26/2025
Section Cited
CCR
87309(a)

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(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
This deficiency is evidenced by:
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Staff removed the scissors and made them inaccessible to residents in care.
***No further action required***
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Based on observation by LPAs and Director of Health Services during tour of facility licensee did not ensure staff locked up 3 pairs of scissors left unattended in the unlocked wellness room at 9:50AM on the second floor of dementia care facility which poses a immediate risk to the health, safety, or personal rights of the persons in care.
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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 Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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