197608181-8-13-2020-28-AS-MVAO-BUEPDV-20201015111409

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608181
Report Date: 08/12/2020
Date Signed: 08/13/2020 02:41:34 PM

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
01/30/2020 and conducted by Evaluator Elizabeth Irra

COMPLAINT CONTROL NUMBER: 28-AS-20200130111424

FACILITY NAME:	SILVERADO SENIOR LIVING - SIERRA VISTA		FACILITY NUMBER:	197608181
ADMINISTRATOR:	GWINN, ALMAVIDA		FACILITY TYPE:	740
ADDRESS:	125 W SIERRA MADRE AVE		TELEPHONE:	(626) 812-9777
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	87	CENSUS: 74	DATE:	08/12/2020
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Selene Rangel-Gutierrez		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff not providing residents medication as prescribed.
Facility not providing authorized representative information in a timely manner.
Staff not meeting residents needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra initiated a subsequent complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Selene Rangel-Gutierrez (Director of Health Services). The initial 10-day investigation was conducted on 02/05/2020.

On 08/11/2020, at approximately 1:00 P.M, LPA Irra conducted a telephone interviews with the Facility Administrator and Director of Health Services. During today's investigation, LPA attempted to interview R-1 (unable to interview due to Dementia), LPA unable to interview Residents within the same building as R-1 and was unsuccessful as all Residents have Dementia/Alzheimer's. LPA interviewed R-2 through R-4 from the next door building. LPA also interviewed Staff.

***Refer to LIC 9099C for the continuation of this report***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020

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-20200130111424

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 - SIERRA VISTA	FACILITY NUMBER: 197608181
	VISIT DATE: 08/12/2020

NARRATIVE

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Allegation: Staff not providing residents medication as prescribed. During this investigation, LPA interviewed the Facility Administrator and Director of Health Services. LPA attempted to interview R-1 (unable to interview due to Dementia), LPA unable to interview Residents within the same building as R-1 as all Residents have Dementia/Alzheimer's. LPA interviewed R-2 through R-4 from the next door building. Interviewed Residents indicated they are given their medication as prescribed and do no have any concerns. LPA also interviewed Staff. Interviewed staff indicated residents are provided with medication as prescribed. Interviewed staff indicated they do no administer any over-the-counter medication that does not have a Physician's order. LPA was unable to interview R-1. LPA obtained and reviewed Medication List for R-1 and medication has been administered as prescribed.

Allegation: Facility not providing authorized representative information in a timely manner. During this investigation, LPA interviewed the Facility Administrator and Director of Health Services. LPA attempted to interview R-1 (unable to interview due to Dementia), LPA unable to interview Residents within the same building as R-1 as all Residents have Dementia/Alzheimer's. LPA interviewed R-2 through R-4 from the next door building. Interviewed Residents indicated that staff maintain their authorized representatives/significant others informed of their status at all times. LPA also interviewed Staff. Interviewed staff indicated they maintain authorized representatives informed and provide information of Residents health/condition/needs. Interviewed staff indicated there are Service Plan Conferences that take place to discuss the residents conditions, needs and services. Per interviewed staff, authorized representatives are invited to participate in these meetings.

Allegation: Staff not meeting residents needs. During this investigation, LPA interviewed the Facility Administrator and Director of Health Services. LPA attempted to interview R-1 (unable to interview due to Dementia), LPA unable to interview Residents within the same building as R-1 as all Residents have Dementia/Alzheimer's. LPA interviewed R-2 through R-4 from the next door building. Interviewed Residents indicated that staff are meeting their needs and do not have any concerns. LPA also interviewed Staff. Interviewed staff indicated resident needs are being met. Interviewed staff indicated that R-1's Authorized Representative schedules and takes R-1 to all medical consultations. Additionally, interviewed staff indicated there are Service Plan Conferences that take place to discuss the residents conditions (including dental hygiene and incontinence care), needs and services. Per interviewed staff, authorized representatives are invited to participate in these meetings.
**** REFER TO LIC 9099 FOR THE CONTINUATION OF THIS REPORT****

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200130111424

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 - SIERRA VISTA	FACILITY NUMBER: 197608181
	VISIT DATE: 08/12/2020

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview, a copy of this report (sent electronically for signature) and Appeals Rights were provided to Selene Rangel-Gutierrez (Director of Health Services).

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2020

LIC9099 (FAS) - (06/04)

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