197609117-6-1-2020-29-AS-MVAO-BQ8MCA-20200603092910

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609117
Report Date: 06/01/2020
Date Signed: 06/01/2020 04:51:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/22/2020 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20200522145434

FACILITY NAME:	SILVERADO SENIOR LIVING - CALABASAS		FACILITY NUMBER:	197609117
ADMINISTRATOR:	GIUNTO, TAYLOR		FACILITY TYPE:	740
ADDRESS:	25100 CALABASAS RD		TELEPHONE:	(818) 222-1000
CITY:	CALABASAS	STATE: CA	ZIP CODE:	91302
CAPACITY:	110	CENSUS: 49	DATE:	06/01/2020
		UNANNOUNCED	TIME BEGAN:	04:40 PM
MET WITH:	Taylor Giunto		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff caused injury to resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith initiated a subsequent complaint investigation to deliver the findings for the above allegation. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Executive Director Taylor Giunto.

On 5/22/2020, the LPA completed the initial visit and interviewed the Executive Director and requested documents. On 5/28/2020, the LPA reviewed video footage pertaining to the allegation. On 5/29/2020, the LPA interviewed a family member at 11:01am, interviewed the Executive Director at 10:27am, and interviewed staff at 2:32pm, 2;37pm, 2:44pm, 2:55pm, 3:03pm, 3:09pm, 3:15pm and 3:20pm. On 6/1/2020, the LPA interviewed a staff at 2:14pm and resident #1 (R1) at 3:04pm.

CONT on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2020

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 29-AS-20200522145434

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS	FACILITY NUMBER: 197609117
	VISIT DATE: 06/01/2020

NARRATIVE

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Regarding the allegation: Staff caused injury to resident while in care

The complainant alleged that resident #1 (R1) was hit by staff and sustained a bruise. This facility self-reported an incident on 5/18/2020, nothing that R1 fell on 5/13/2020. Follow-up interviews revealed that R1 sustained a bruise as a result of hitting an object during the fall. The LPA reviewed video footage of the incident, and it was revealed that R1 lost their footing and fell as a result. Staff were not observed hitting R1; however, R1 was observed falling into an object, which is how the bruise was sustained. Interviews conducted with witnesses to the incident confirmed that R1 was not hit by staff. Interviews with staff and a responsible party revealed that staff interact appropriately with all residents at this facility, including R1. Interviews negated ever observing staff being physically aggressive towards residents in any fashion. Information obtained from R1 was inconclusive.

Based on the information obtained, there is insufficient evidence to support the claim that staff caused injury to resident while in care. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was emailed to the Executive Director to obtain signature.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2020

LIC9099 (FAS) - (06/04)

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