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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608180
Report Date: 10/11/2022
Date Signed: 10/11/2022 04:44:19 PM


Document Has Been Signed on 10/11/2022 04:44 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:TANA MCMILLONFACILITY TYPE:
740
ADDRESS:1118 N STONEMAN AVETELEPHONE:
(626) 308-9777
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:62CENSUS: 39DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Arienne Ghammangne, Director of Health ServicesTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted an annual inspection with the focus of the infection control. LPA arrived unannounced and met with Arienne Ghammangne, the Director of Health Services, and explained the purpose of the visit. The facility is licensed to serve 62 bedridden residents ages 60 and over and provides dementia care. There is an approved hospice waiver for 10 residents. The Administrator's certificate expires on 1/21/23.

During the visit today, LPA Chan toured the facility, reviewed files, and interviewed residents and staff. The following were observed or inspected:
* The facility screens all visitors and staff upon arrival at the facility.
* There are hand sanitizing stations throughout the facility.
* COVID-19 signage are posted at the main entrance and around the facility.
* All the rooms inspected had the required furnishings.
* Soap and paper towels are available in the rooms and in common areas.
* The facility has a sufficient food supply of 2-day perishable and a week of non-perishable. Foods are covered and handled properly to avoid cross contamination.
* Staff were observed wearing face masks.
* At least 30 days of PPE supplies are stored at the facility.
* LPA reviewed files for 5 Residents and all have the updated emergency contact information and physician's report. Files were reviewed for 6 Staff and all have criminal background clearances.
* Medications are centrally stored and locked. LPA reviewed 6 residents' medications and there were no discrepancies found.

There were no deficiencies observed during the visit today. An exit interview was held and a copy of this report along with the appeal rights were given to the Director of Health Services.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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