197609117-9-20-2022-29-AS-JAPL-CJHQJD-20220922121233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609117
Report Date: 09/20/2022
Date Signed: 09/20/2022 01:30:19 PM

Unsubstantiated

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
06/03/2022 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20220603162155

FACILITY NAME:	SILVERADO SENIOR LIVING - CALABASAS		FACILITY NUMBER:	197609117
ADMINISTRATOR:	VIDA GWINN		FACILITY TYPE:	740
ADDRESS:	25100 CALABASAS RD		TELEPHONE:	(818) 222-1000
CITY:	CALABASAS	STATE: CA	ZIP CODE:	91302
CAPACITY:	110	CENSUS: 50	DATE:	09/20/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Selene Rangel		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Due to lack of supervision, resident hit another resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA met with Selene Rangel and explained the reason for the visit.

During the 6/7/2022 visit, the LPA completed a file review, obtained documents, and interviewed staff from 10:20 a.m. - 11:20 a.m. Today, the LPA interviewed staff at 10:30 a.m., 10:39 a.m., 10:58 a.m., 11:15 a.m., and 11:33 a.m., and reviewed documents.

It was alleged that due to lack of supervision, Resident #1 (R1) was assaulted by Resident #2 (R2). Witnesses revealed that on 5/10/2022, R1 and R2 were in the lobby. R1 was sitting in the lobby, and R2 approached R1 and asked R1 to leave the lobby with R2. R1 refused to go with R2, in which R2 responded by hitting R1 on the right side of R1’s head. R1 and R2 were immediately separated and both residents were assessed and had no visible injuries. The facility physician and the responsible parties for both residents were notified. Facility staff called 9-1-1, in which upon arrival, neither R1 nor R2 recalled the incident.

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: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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-20220603162155

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: 09/20/2022

NARRATIVE

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Records review noted that R2 moved into the facility on 3/10/2022. A review of R2’s physician’s report dated 10/29/2021 and care plan dated 4/6/2022 indicated that R2 had a tendency to be affectionate towards other residents by way of wanting to hold their hands. Interviews and a review of Facility Progress Notes prior to the incident revealed that R2 was combative towards staff while receiving care. At the time of the incident, R2 did not display violent or aggressive behaviors towards other residents. Hence, the 5/10/2022 incident appeared to be an isolated event. R1 had resided in the facility since 2019 and staff indicated that R1 had not been violent towards anyone. A review of care plans revealed that neither resident required 1:1 supervision at that time. R2 was seen by the facility’s psychiatrist on 5/10/2022 and had a medication adjustment.

Interviews confirmed that oftentimes, it was hard to predict resident behaviors and certain triggers, and witnesses to the 5/10/2022 event claimed that they were not able to intervene in time, as the behavior was sudden. In response to residents whom display aggressive behaviors, staff responses include but are not limited to: conducting frequent checks; notifying a resident’s physician regarding the escalating behavior to determine if a medication adjustment is needed; assessing for a change of condition and/or pain that may be contributing to the behavioral change; and/or potentially assigning a 1:1 companion to the resident for additional oversight and safety monitoring.

However, interviews and a review of Facility Progress Notes demonstrated that R2 continued to display aggressive behavior after the 5/10/2022 incident. The facility tried several interventions in response to R2’s behavior, which included reducing outside stimuli, medication adjustments, and assigning a 1:1 companion to R2. Staff claimed there were no identifiable triggers and felt R2’s behaviors were sporadic and unpredictable. A 1:1 caregiver was assigned to R2 on 5/22/2022 as R2 was becoming increasingly aggressive when other facility residents refused to hold R2’s hand. R2 was again seen by the facility psychiatrist on 6/2/2022 due to their behaviors. The facility continued to monitor R2’s behavior and on 6/28/2022, R2 was hospitalized for a possible 51/50 due to the risk of harming others. Whereas R2 eventually returned to the facility with a 1:1 companion, R2’s behavior continued to escalate and R2 moved out of the community on 8/1/2022.

Based on the information gathered, there is insufficient evidence to support the claim that due to lack of supervision, R1 was assaulted by R2. As R2's behaviors increased, the facility appropriately intervened. Regarding the 5/10/2022 incident, the police whom responded to the 9-1-1 call determined that there was no intent to harm. The allegation is Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was emailed for signature.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC9099 (FAS) - (06/04)

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