197608182-8-13-2021-11-AS-MVAO-C67PFA-20210824111622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608182
Report Date: 08/13/2021
Date Signed: 08/13/2021 05:55:58 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 DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/29/2020 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200529144134

FACILITY NAME:	SILVERADO SENIOR LIVING - BEVERLY PLACE		FACILITY NUMBER:	197608182
ADMINISTRATOR:	RUSSO, JASON		FACILITY TYPE:	740
ADDRESS:	330 N HAYWORTH AVE		TELEPHONE:	(323) 852-9200
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	0	CENSUS: 108	DATE:	08/13/2021
		UNANNOUNCED	TIME BEGAN:	09:41 AM
MET WITH:	MYLA BENSON & JESSICA PONCE		TIME COMPLETED:	10:39 AM

ALLEGATION(S):

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Failure to follow proper admission procedures.

INVESTIGATION FINDINGS:

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On 08/13/21, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit at this facility. LPA met with Administrator Myla Belson and Assistant Director of Health Services Jessica Ponce. LPA explained the purpose of today's visit is to deliver findings for the allegation mentioned above.

The investigation consisted of the following: The Department inquired questions relevant to the nature of the complaint allegation with staff (S1-S6), residents (R1-R9), and witnesses (W1-W6). A review of (R1-R10) service records and other pertinent documents related to this investigation. A virtual inspection on 06/08/20 and in-person 05/21/21 tour of this facility.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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 11-AS-20200529144134

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: SILVERADO SENIOR LIVING - BEVERLY PLACE	FACILITY NUMBER: 197608182
	VISIT DATE: 08/13/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Failure to follow proper admission procedures.
The complainant alleges the facility failed to follow proper admission procedures when admitting resident #1 (R1). Interviews were conducted with staff #1-#6 (S1-S6), residents #1-#9 (R1-R9), witness #1-#6 (W1-W6) service records for residents #1-#10 (R1-R10), and other pertinent documents in association to this complaint were reviewed, a plant inspection of this facility and found there is no evidence to support the above allegation.

The Department conducted a virtual inspection on 06/08/20 of this facility. Due to the COVID-19 pandemic and PIN 20-07-CCLD on-site visits were suspended. During this visit, an interview with the administrator revealed the facility adhered to the admissions procedures and did not deflect from the standard move-in process for all newly admitted residents during COVID. Interviews with staff (S1-S6) reports resident must go through the proper comprehensive admission process in which includes initial assessments and medical screening. This involved in-person or virtual communications with the facility’s: Family Ambassador, Department of Health Services, Admission Agreement Representative, Director/Administrator; Program Director, and Director of Engagement before a move-in is finalized and approved. According to staff (S1 and S2), added precaution screening for COVID was implemented on 03/13/20 along with the admissions process. An interview with residents (R1-R5) verified the facility conducts a complete admittance process which included medical evaluation for each resident before granting residency. Interviews with family representatives (W1-W4) all validated that the proper protocols and admissions process was followed.

The Department conducted a subsequent on-site inspection on 05/21/21. During this visit, a follow-up interview was conducted with staff (S1) and gathered additional records concerning (R1). A further review of (R1’s) service records along with an interview with the resident revealed, (R1) had undergone the proper protocols of admissions guidelines and was screened for COVID before admission was granted.
The investigation consisted of an inspection of the facility, observation, review of service records, pertinent related documents, and interviews with staff, residents, and witnesses all revealed the facility did not divert from following proper admission guideline procedures.

Evaluation Report continues on LIC-9099C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20200529144134

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: SILVERADO SENIOR LIVING - BEVERLY PLACE	FACILITY NUMBER: 197608182
	VISIT DATE: 08/13/2021

NARRATIVE

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Based on information gathered, the Department did not find sufficient evidence to support the allegation: “Failure to follow proper admission procedures”.

Although the allegation may have happened or is valid, there is not enough preponderance of evidence to prove the alleged allegation is valid did or did not occur. Therefore, the allegation is "unsubstantiated”.

No deficiencies were cited on this visit.

An exit interview was conducted with Myla Belson, and a hard copy was provided by email.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC9099 (FAS) - (06/04)

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