197608180-7-7-2022-28-AS-MVAO-CJGP7Q-20220921110418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608180
Report Date: 07/07/2022
Date Signed: 07/07/2022 12:41:00 PM

Substantiated

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
06/04/2021 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210604082224

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: 39	DATE:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Rochelle Carpio, Administrator		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Resident was not accorded dignity in relationships with staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint visit to deliver findings for the allegation listed above. LPA met with Rochelle Carpio, Administrator, and explained the purpose of the visit.

On 6/4/21, LPA Chan conducted a health and safety check and did not observe any immediate concerns. LPA requested for documents pertaining to 3 residents. During the visit today, LPA interviewed 3 Staff and 3 Residents.

Regarding allegation – Resident was not accorded dignity in relationships with staff. The incident occurred on 6/4/21 where Resident #1 (R-1) requested to go to the toilet, but the NOC shift staff did not listen to resident. The resident was then taken to the restroom by staff in the morning shift and had a bowel movement.

(Continue on LIC9099C)

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: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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-20210604082224

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: 07/07/2022

NARRATIVE

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According to Investigation Bureau Investigator’s interviews with Administrator Ahmed and 6 staff in relation to this complaint, one of the staff (S-1) admitted that on 6/4/21, Resident #1 (R-1) had said all night that R-1 needed to go to the bathroom. Since S-1 had just finished putting on a fresh brief on resident, S-1 just checked on resident to see if it was soiled. S-1 also stated that it was the first night R-1 had made numerous requests to be moved to the toilet. S-1 did not believe R-1 truly needed to have a bowel movement and had never been required to move R-1 out of the bed to the toilet during the NOC shift. However, S-1 acknowledged that other residents on the NOC shift were transferred from their beds to the toilet. LPA Chan interviewed additional 3 Staff and confirmed that when a resident request to be changed or taken to the toilet, the staff must assist the resident even if the resident requires two people to transfer. LPA interviewed 3 residents today and they stated that staff are good and assist with diaper change and/or going to the toilet. Administrator Ahmed confirmed that S-1 had been terminated and no longer working at the facility.

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), is being cited on the attached LIC 9099D.

An exit interview was conducted. The Plan of Corrections were reviewed and developed with the Administrator. A copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210604082224

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: 07/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/14/2022 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator shall conduct an in-service training as a reminder to all staff regarding personal rights. The POC shall be submitted to LPA by POC due date 7/14/22. POC has been cleared as of 7/7/22*
	8 9 10 11 12 13 14	Based on interviews, S-1 admitted to not taking R-1 to sit on the toilet when requested on 6/4/21 which poses a potential 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: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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