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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608180
Report Date: 09/13/2022
Date Signed: 09/13/2022 03:02:18 PM

Unsubstantiated


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 HUNTINGTONFACILITY NUMBER:
197608180
ADMINISTRATOR:SAFOORA AHMEDFACILITY TYPE:
740
ADDRESS:1118 N STONEMAN AVETELEPHONE:
(626) 308-9777
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:62CENSUS: 39DATE:
09/13/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Rochelle Carpio, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident sustained an injury while in care.
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.

The investigation consisted of the following:

On 6/4/21, LPA Chan conducted a health and safety check and did not observe any immediate concerns. Documentations were requested and obtained for 3 residents. This allegation was assigned to the Investigations Bureau (IB) Investigator Brian Slatic to further investigate.

(continue on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
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 5
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: 09/13/2022
NARRATIVE
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The investigation revealed the following:

Allegation - Resident sustained an injury while in care. It was alleged that Resident #1 (R-1) sustained a severe UTI as a result of being left in soiled diapers for extended periods of time. The Investigations Branch (IB) Investigator Brian Slatic conducted the investigation on this allegation. All the staff interviewed denied R-1 was left in a soiled diaper for extended periods of time. The facility policy requires the residents to be checked at least every 2 hours. In addition, Investigator Slatic obtained and reviewed hospital records for this investigation. Although R-1 did sustain an UTI, it cannot be conclusively shown that it was a result of lack of staff supervision or neglect. Based on interviews and records reviewed by the Investigator, there is not supportive evidence to concur with this allegation.

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



An exit interview was conducted with the Administrator. A copy of this report along with the appeal rights were provided.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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 HUNTINGTONFACILITY NUMBER:
197608180
ADMINISTRATOR:SAFOORA AHMEDFACILITY TYPE:
740
ADDRESS:1118 N STONEMAN AVETELEPHONE:
(626) 308-9777
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:62CENSUS: 39DATE:
09/13/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Rochelle Carpio, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not meeting toileting needs of resident.
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.

The investigation consisted of the following:
On 6/4/21, LPA Chan conducted a health and safety check and did not observe any immediate concerns. Documentations were requested and obtained for 3 residents. This allegation was assigned to the Investigations Bureau (IB) Investigator Brian Slatic to further investigate.

The investigation revealed the following:
Allegation – Staff are not meeting toileting needs of resident. IB Investigator Slatic interviewed Administrator Ahmed and 6 Staff during his investigation. (continue on LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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: 09/13/2022
NARRATIVE
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One of the six staff admitted that Resident #1 (R-1) had requested to be moved to the toilet on 6/4/21 but did not take resident to the toilet. Staff indicated a fresh brief was placed on R-1 and checked on resident every 2 hours instead. R-1 had requested to use the toilet all night and Staff did not believe resident needed to have a bowel movement. It was also noted that R-1 was never transferred out of the bed to the toilet during the NOC shift and that resident required two-person transfer. The other 5 staff who the investigator interviewed denied neglecting any resident's request to be transferred to the restroom. They would honor any residents' requests and take them to use the toilet.


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. 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 HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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: 09/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2022
Section Cited
CCR
87625(b)(1)
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87625 Managed Incontinence
(b) In addition to Section 87611,... the licensee shall be responsible for the following:
(1) Ensuring that residents who can benefit from scheduled toileting are assisted...rather than being diapered.
This requirement is not met as evidenced by:
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The Administrator shall conduct an in-service training to care staff in regards to managing residents who are incontinence and who can benefit from a scheduled toileting as opposed to being diapered. The training log shall be submitted to LPA by POC due date 9/27/22.
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Based on staff interview, the Administrator did not ensure that resident is being transferred to the toilet upon request which poses a potential health, safety, and personal rights risk to residents 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 HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5