197609117-11-29-2021-29-AS-ASMH-C98RUH-20211129121958

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609117
Report Date: 11/29/2021
Date Signed: 11/29/2021 12:20:25 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR:	GIUNTO, TAYLOR		FACILITY TYPE:	740
ADDRESS:	25100 CALABASAS RD		TELEPHONE:	(818) 222-1000
CITY:	CALABASAS	STATE: CA	ZIP CODE:	91302
CAPACITY:	110	CENSUS: 58	DATE:	11/29/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Taylor Giunto		TIME COMPLETED:	12:20 PM

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

Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced Case Management visit to the above facility. The purpose of the visit is to follow up on the substantiated allegation of neglect/lack of care and supervision. The LPA met with Executive Director Taylor Giunto and explained the reason for the visit.

On July 3, 2018, the Department received a complaint which contained the allegations: Facility staff failed to provide proper care and supervision to Resident #1 (R1) which contributed to R1’s death; and, facility staff failed to seek timely medical attention for R1.

The above allegations were substantiated, and on January 31, 2019, the licensee was cited for violating California Code of Regulations (CCR) Title 22, 87464(f)(1) Basic Services due to failure to provide R1 with proper care and supervision relating to assistance with activities of daily living. Citations were also issued under 87465(g) Incidental Medical and Dental Care for failure to obtain timely medical attention for R1 by failing to call 9-1-1 immediately upon finding R1 in an unresponsive state. The licensee was further cited under section 87411(a) Personnel Requirements – General for not having competent staff to ensure R1 was monitored and ate after receiving insulin, and subsequently failing to contact emergency services for R1 in a timely manner. Lastly, the licensee was issued a citation under section 87405(d)(1)(2) Administrator – Qualifications and Duties for the administrator not providing staff with appropriate training to ensure R1 was afforded appropriate care and supervision, which ultimately contributed to the death of R1.

On January 31, 2019, an immediate civil penalty of $500 was also assessed for the violation of CCR Title 22, Section 87464(f)(1) Basic Services. An appeal was issued by the licensee, and the deficiency 87464(f)(1) Basic Services was dismissed. On November 29, 2021, the allegation “Facility staff failed to provide proper care and supervision to Resident #1 (R1) which resulted in R1’s death” was changed from Substantiated to Unsubstantiated and the $500 civil penalty was dismissed.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/29/2021

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

On August 23, 2021, the Department issued a civil penalty per Health and Safety Code §1569.49 in the amount of $9,500 for a violation that the Department constitutes as serious bodily injury. Today, the Department is assessing a $500 civil penalty for the facility staff’s failure to provide proper care and supervision to R1, which resulted in serious bodily injury.

Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC 809-D).

Exit Interview Conducted. Civil penalty issued. Appeal Rights Discussed. A Copy of Report Issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/29/2021 Section Cited	1 2 3 4 5 6 7	87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities. Residents shall have all of the following...: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as staff failed to provide proper care to R1 after administering insulin, resulting in R1 becoming hospitalized, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	An immediate civil penalty of $500 will be assessed. As this is a repeat violation, an additional civil penalty of $1,000 will be assessed today.
	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: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3