197608180-9-13-2022-28-AS-MVAO-CJQRWG-20220929132306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608180
Report Date: 09/13/2022
Date Signed: 09/13/2022 03:20:45 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
07/25/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220725160039

FACILITY NAME:	SILVERADO SENIOR LIVING - THE HUNTINGTON		FACILITY NUMBER:	197608180
ADMINISTRATOR:	TANA MCMILLON		FACILITY TYPE:	740
ADDRESS:	1118 N STONEMAN AVE		TELEPHONE:	(626) 308-9777
CITY:	ALHAMBRA	STATE: CA	ZIP CODE:	91801
CAPACITY:	62	CENSUS: 39	DATE:	09/13/2022
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Rochelle Carpio, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff inappropriately handled resident resulting in injury.

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 7/27/22, LPA Chan toured the facility and observed the facility to be well-maintained. LPA also observed sufficient food supplies of perishable and nonperishable items. There were no immediate health and safety concerns at time of visit. LPA obtained copies of the staff roster, resident roster, and Resident #1's documents. During this investigation, interviews were conducted with the Administrator, 5 staff, and 2 personal caregivers.

Unsubstantiated

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: 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)

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Control Number 28-AS-20220725160039

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:

Regarding allegation - Facility staff inappropriately handled resident resulting in injury. It is alleged that one of the staff member was squeezing the hand of Resident #1 (R-1), resulting with bruises. Per the Administrator, R-1 moved in on 7/16/22 and left the following day 7/17/22. She stated that new admitted residents get a personal one-on-one caregiver, around the clock, for 3 days to help with the transition. LPA interviewed 2 of the personal caregivers and they stated that R-1 did not want to be at the facility. On 7/16/22, R-1 had attempted to leave the facility by pushing on the front door multiple times. Staff and personal caregiver were able to redirect resident. One of the evening shift staff observed the resident hitting the windows, table, and the door due to not wanting to be there. On 7/17/22, R-1 went to the front door and continuously pushed on the front door. Staff on duty attempted to redirect but were unsuccessful. They stayed with R-1 as resident continue to push on the door until the delayed egress was deactivated. R-1 ran out of the facility where 3 staff followed. All the staff interviewed denied grabbing or squeezing R-1 nor did they observe other staff touching resident. They tried to intervene by verbally redirecting the resident. R-1 safely relocated to the In and Out across the street and did not return to the facility. Based on the information gathered from interviews, there is not enough evidence to support 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 Administrator. A copy of this report along with the 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: 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)

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