197609117-9-13-2021-31-AS-JAPL-C6VKY8-20210915081840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609117
Report Date: 09/13/2021
Date Signed: 09/13/2021 04:57:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/14/2019 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 31-AS-20191014113600

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: 57	DATE:	09/13/2021
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Taylor Giunto		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Residents sustained pressure injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced subsequent complaint visit to the above facility to conclude an investigation initiated by LPA Heffernan on 10/18/2019. Upon arrival, the LPA met with Executive Director Taylor Giunto and explained the reason for the visit.

On 10/14/2019, the Department received a complaint alleging residents sustained pressure injuries while in care. The allegation was specifically focused on three residents. On 11/26/2019 at 11:10am, LPA interviewed the Executive Director Giunto, who stated Resident #1 (R1) previously had a wound on R1’s heel, but it had since healed. The Executive Director was unaware of any pressure injuries sustained by Resident #2 (R2) or Resident #3 (R3) but noted that all three residents were receiving hospice services while residing at the facility. An additional interview with staff on 11/26/2019 at 2:54pm, revealed R1 had a small wound on R1’s right heel due to boots that rub against R1’s wheelchair feet which causes friction.

CONT 9099-C

Substantiated

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: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

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 31-AS-20191014113600

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS	FACILITY NUMBER: 197609117
	VISIT DATE: 09/13/2021

NARRATIVE

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However, staff prop R1’s feet up at night so that R1’s heels are dangling and not touching the bed. In addition, staff stated R2 had started to develop a pressure injury on R2’s coccyx recently but was being treated by hospice. Staff confirmed R3 may have had one pressure injury on R3’s hip or lateral thigh, but confirmed R3 had suffered a bad reaction to medication which caused R3 to turn red and make R3’s skin peel. The facility provided an opti-foam padding on R3’s mattress for extra support.

A review of records on 03/12/2020, beginning at 9:30am, indicated R1 was admitted to the facility on 02/26/2019 and hospice services were initiated on 04/10/2019. Hospice notes indicate during R1’s initial assessment on 04/10/2019, wound care was performed on a stage III pressure injury measuring 5 cm X 5 cm X 0.2 cm on R1’s left heel. R2 was noted to have pressure injuries on R2’s buttocks and right ankle but receiving wound care from 12/11/2019-2/17/2020. However, hospice services were initiated for R2 on 01/13/2017. R3 was admitted to the facility on 09/25/2015 and hospice services were initiated on 04/01/2017.

In summary, R1 was admitted to the facility on 02/26/2019 and a stage III pressure injury was noted on R1’s left heel during the initial assessment for hospice care on 04/10/2019. Whereas R2 and R3 sustained pressure injuries, the above-mentioned pressure injuries for R2 and R3 received appropriate care under the supervision of an appropriately skilled professional. There was no evidence to determine that R1 received appropriate wound care from either a home health or hospice agency prior to the assessment of the stage III pressure injury on 04/10/2019. A file review revealed that an exception was not filed to retain R1 in the facility with a stage III injury prior to receiving hospice care, nor did documents confirm that R1 received any wound care prior to the 04/10/2019 assessment date. Based on the investigation, there is sufficient evidence to support the claim that R1 sustained pressure injuries while in care. This allegation is deemed Substantiated at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

Exit interview conducted, today's reports and appeal rights were reviewed and issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20191014113600

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS	FACILITY NUMBER: 197609117
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/13/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/15/2021 Section Cited CCR 87615(a)(1)	1 2 3 4 5 6 7	87615(a)(1) Prohibited Health Conditions. Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained … (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator agreed to do the following: 1. Host an in-service training with care staff, regarding regulation 87615 Prohibited Health Conditions and 87631 Healing Wounds. Communicate scheduled date to the Department by 9/15/2021. Training must be completed within two weeks.
	8 9 10 11 12 13 14	Based on interview and records review, the licensee did not comply with the section cited above, as R1 was retained in the facility with a stage III pressure injury, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

LIC9099 (FAS) - (06/04)

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