197608181-7-8-2021-28-AS-MVAO-C55TQB-20210721145540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608181
Report Date: 07/08/2021
Date Signed: 07/08/2021 01:48:06 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
10/14/2020 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201014133604

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:	0	CENSUS: 0	DATE:	07/08/2021
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Selene Rangel-Gutierrez; Director of Health Care Services		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident sustained unexplained bruising while in care.
Resident's diapering needs are not being met.
Resident's dietary needs are not being met.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) David Sicairos and Luis Mora conducted a subsequent complaint investigation regarding the allegations listed above. LPAs met with Selene Rangel Director of Health Services and explained the reason for the visit.

The investigation consisted of the following: during virtual visit conducted on 10/15/20, LPA conducted virtual tour of the facility and obtained copies of resident and staff rosters. During today's visit LPA reviewed Former Resident #1's (FR1) file and conducted interviews with Staff #1 (S1) - Staff #4 (S4) and Resident #1 (R1) - Resident #4 (R4). LPA also attempted to interview FR1 at their current facility, however LPA was unable to obtain any information due to FR1's cognitive impairment.

The investigation revealed the following: in regards to the allegation "resident sustained unexplained bruising while in care", it is alleged that FR1 had bruises on her right forearm that were covered by an arthritis compression sleeve upon discharge from the facility.

(CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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-20201014133604

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: 07/08/2021

NARRATIVE

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FR1 moved into this facility on 10/23/19 and moved out on 10/10/20. Per interview conducted with Director of Health Care Services, FR1 had blood work done off-site on 09/30/20. The laboratory had trouble withdrawing blood from FR1 which caused bruising in the right forearm area. Facility staff denied having caused the bruising. Review of FR1's Physician Orders also show that FR1 was taking Aspirin which sometimes can cause thinning of the blood. LPA did not find any evidence showing that the bruising observed on FR1 was caused due to staff neglect or abuse. Therefore there was insufficient to corroborate with allegation.

In regards to the allegation "resident's diapering needs are not being met", it is alleged that upon discharge of the facility FR1 was observed with a diaper rash. Per interview conducted with Director of Health Care Services, prior to discharge on 10/08/20, a full body check of FR1 was conducted by her and she did not observe any diaper rash on FR1. LPA obtained Discharge/Progress Notes dated 10/10/20 for FR1 indicating that "resident's skin is intact at the time of transfer". Interviews conducted with staff members all indicated that residents are checked on at least every 2 hours to ensure that they have not urinated or defecated on themselves or to provide any other type of assistance. Interviews conducted with R1 - R4 indicated that their diapering needs are being met. Therefore there was insufficient evidence to corroborate with allegation.

In regards to the allegation "resident's dietary needs are not being met", it is alleged that FR1 is not able to eat solid foods because of choking. The resident had a swallow assessment done by a doctor and the doctor stated she is only to eat puree foods. The staff were allegedly still giving her solid foods. LPA reviewed FR1's Physician Order which indicates that FR1 was placed on a pureed food & nectar thickened liquids diet on 11/7/19. A "post swallow study" was conducted on 01/30/20 which indicated that FR1 would continue on a pureed food & nectar thickened liquids diet. Interviews conducted with staff members revealed that resident meals are prepared based on physician's orders. Interviews conducted with staff members indicated that they assist residents with feeding and make sure before the resident is fed that they are receiving their correct diet. Interviews conducted with R1 - R4 indicated that their dietary needs are being met. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held and a copy of this report was provided. This facility closed effective 03/08/21 due to a Change in Ownership. Hard copy of this report will be mailed to last known mailing address.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC9099 (FAS) - (06/04)

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