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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609117
Report Date: 12/12/2024
Date Signed: 12/13/2024 09:32:34 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
08/07/2023 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20230807152205
FACILITY NAME:SILVERADO SENIOR LIVING - CALABASASFACILITY NUMBER:
197609117
ADMINISTRATOR:TERRI WEITZMANFACILITY TYPE:
740
ADDRESS:25100 CALABASAS RDTELEPHONE:
(818) 222-1000
CITY:CALABASASSTATE: CAZIP CODE:
91302
CAPACITY:110CENSUS: 45DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Patrice O'GradyTIME COMPLETED:
07:00 PM
ALLEGATION(S):
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Staff did not address a change in the resident's condition.
Staff do not ensure resident's hygiene needs are met.
Staff locked resident in their room.
Staff do not provide resident clean linens.
The facility has no means for residents to call for assistance.
Staff did not provide resident PRN medication as needed.
INVESTIGATION FINDINGS:
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12/12/2024: Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to investigate the allegations listed above. The LPA met with the Administrator Patrice O’Grady and explained the reason for the visit. The LPA requested additional records at 12:25 p.m.

On 08/15/2023, Licensing Program Analyst (LPA) Elsie Campos arrived unannounced to conduct an initial 10-day complaint visit. The LPA met with Administrator Terri Wheitzman and explained the reason for the visit.

Continues on LIC 9099C... page 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 11
Control Number 29-AS-20230807152205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS
FACILITY NUMBER: 197609117
VISIT DATE: 12/12/2024
NARRATIVE
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Staff did not address a change in the resident's condition.
It is alleged that staff did not address a change in R1’s condition, and the concern of the Reporting Party (RP) is that the results of a swallow test given to R1, showed that R1can only eat pureed foods (pudding like). To investigate the allegation LPA Urena conducted record review and interviewed the RP. The LPA was unable to interview the facility Administrator employed at the time when the complaint was received by the Department, or the Director of Health Services (DHS), as they are no longer employed at the facility. Medical records obtained by the LPA indicates that on 05/24/2023, R1 had a Neurology Outpatient visit and the medical provider notes indicate that R1 was accompanied by R1’s POA, facility Administrator Terri Weitzman, and a facility caregiver. Furthermore, the case notes indicate that at the time of the visit; it was noted that R1 had developed dysphagia (difficulty swallowing) to solid foods in early 2023, and the recommendation was to provide R1 with soft moistened solids, purees, thin liquids, and with direct staff supervision. On 06/02/2023, the POA communicated via email with the DHS to inform them that during a visit with R1, the POA observed that R1 had a plate of breakfast in their room, and the POA asked that R1 eat in the dining room where R1 could be supervised during meals. On 09/08/2023, the POA communicated via email with the DHS and two other facility staff about the concern of R1 not having breakfast and lunch meal during a recent doctor’s appointment, in which day, R1 returned late to the facility from the appointment, and the dining room was closed, consequently the R1 had to wait for dinner time, and someone (staff) provided R1 with chips and crackers to hold R1 over till dinner time.
On 12/04/2024 the LPA reviewed records provided by the facility. Record review indicates that the facility received Diet Recommendations from the Speech Therapist at Rancho Los Amigos Rehabilitation Center on 07/12/2023. The recommendations indicate that R1 needs to receive a diet of puree foods, and nectar thick liquids. The recommendations include three (3) pages with a detailed description of a ‘Puree diet purpose’, ‘Description of the diet’, ‘Guidelines’, and a ‘Food list’. The recommendations were received by the DHS on 07/12/2023 and given to the culinary staff via a Diet Request Form (DRF) on 07/12/2023. However, the DRF does not indicate in the instructions the specifics of the puree diet, direct supervision by staff during mealtimes, nor did the facility provide documentation as to how the directive was passed on to the direct staff (caregivers, etc.). Continues on LIC 9099C pg.3
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 11
Control Number 29-AS-20230807152205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS
FACILITY NUMBER: 197609117
VISIT DATE: 12/12/2024
NARRATIVE
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Pg. 3
On 12/04/2024, the LPA requested R1’s file for review, and specifically asked for R1’s Resident Appraisal (s) (LIC 603 A), Appraisal Need and Service Plan (LIC 625), Physician’s Report (LIC 602A), but the current Administrator was unable to locate R1’s file at the time of the visit on 12/04/2024. The LPA requested that when the file was located to email the LPA the requested records. Furthermore, on 12/05/2024, the LPA emailed the Administrator reminding them of the requested documents, and as of 12/10/2024, the LPA had not received the requested records. On 12/12/2024, additional records were provided by the Administrator. The Administrator provided appraisal (Service Plan) done by staff on 06/01/2023. Per the Administrator the appraisal is a live document where designated and approved staff can make updates to the document. The Facility’s Service Plan (SA) is dated as Effective Date: 06/01/2023 and Date Scheduled: 09/20/2023. Per the Administrator, the SA can be modified as needed, and the SA indicates the updated Needs/Goals/Action. When the LPA asked the Administrator if the SA was shared with the POA, the Administrator could not say since the SA was created at a time when they were not employed at the facility.
Although the allegation may have happened or is valid, based on record review, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.
Staff do not ensure resident's hygiene needs are met.
On the allegation that staff do not ensure resident's hygiene needs are met; it is the concern of the RP that staff do not shower R1. The RP states that when they spoke to staff about R1’s hygiene, they were told that R1 does not like to take showers. The LPA was unable to interview staff/caregivers related to the allegation due to RP not recalling the name of R1’s caregiver. To investigate the allegation LPA Urena interviewed current staff and conducted record review. The staff’s interviews revealed that staff have a schedule they follow to give showers to residents. Per staff statements, when residents refuse to take showers, the staff/caregivers may delay the shower for the next day or try different approaches to getting the residents’ cooperation to take showers. The staff/caregivers stated that they keep records of the residents who did not get a shower and report during the “exchange” of the staff (AM, PM, NOC). The LVN keeps case notes of the residents who refused showers. The Administrator’s interviewed revealed that staff may attempt to give a shower to a resident but if the resident refuses, the residents cannot be forced, however the refusal of the shower is case noted and other methods to encourage the shower may be used, such as a different time of the day or a different face (caregiver). Continues on pg. 4
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 11
Control Number 29-AS-20230807152205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS
FACILITY NUMBER: 197609117
VISIT DATE: 12/12/2024
NARRATIVE
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Pg. 4
The Regional Support Nurse (RSN) and staff stated that sometimes a PRN is needed (to relax the resident). The LPA interviewed the POA on 12/03/2024, and the RP stated that they were concerned about the hygiene of R1 as R1 had developed an odor, and the POA could tell R1 had not been showered. The POA stated that when they spoke to staff about R1’s hygiene, the POA was told by staff that R1 does not like to take showers, however the staff failed to notify the POA. The POA stated that they had to bring it up to the administrator’s attention for something to be done. The POA stated that after they expressed the concern to the administrator; R1’s shower was moved to a different time of the day, and that seemed to resolve the issue of R1 refusing showers. Record review of the shower schedule that is followed by staff revealed that currently each caregiver has about eight (8) to nine (9) residents per staff. The shower schedule revealed residents have a designated weekday or weekend day (2X per week) for showers.

Although the allegation may have happened or is valid, based on record review, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Staff locked resident in their room.
On the allegation that staff locks resident in their room, it is the concern of the RP that during visits, they have noticed staff locking R1’s door from the outside. R1 is extremely weak and would not be able to open the door from the inside if needed. R1 has fallen a few times because R1 tries to get up on their own when staff do not help. The RP is concerned that staff are locking the resident in their room and do not help with toileting. LPA was unable to interview the Administrator working at the facility during R1’s stay, as the Administrator is no longer employed at the facility. To investigate the allegation LPA Urena conducted a tour of the facility and interviewed the staff and the current Administrator. The Administrator stated that the bedrooms’ doors are kept unlocked from the outside and inside revealed, and they typically keep the rooms’ doors open. The staff, S1, S2, S3, S4, stated that the doors don’t lock from the outside, due to a mechanism in place to prevent door being locked. The LPA toured the facility and inspected six (6) randomly selected rooms’ doorknobs/locks. At the time of the visit, the LPA observed the bedrooms’ doorknobs to have a screw in-place inside and outside the doorknob that prevents the door from being locked from the outside and inside the room.
Continues on Pg. 5
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 11
Control Number 29-AS-20230807152205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS
FACILITY NUMBER: 197609117
VISIT DATE: 12/12/2024
NARRATIVE
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Pg. 5
Although the allegation may have happened or is valid, based on the interviews, and observation, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Staff do not provide resident clean linens.
On the allegation that staff do not provide resident with clean linens; the concern of the RP is about R1 being dirty and malodorous, and the staff do not change R1’s bed linens. The LPA interviewed the POA on 12/03/2024, and the POA stated that staff informed the POA that the linens are changed when the residents get a shower, and at least once a week. To investigate the allegation, on 12/04/2024 LPA Urena interviewed the RSN and current staff. The LPA was unable to interview the staff and the DHS employed at the time of the allegation, due to the staff and the DHS no longer working at the facility at the time the LPA conducted interviews. The RSN stated that the linens are changed as needed and on shower days. The staff interviews revealed that they change linens two times a week and/or on shower days, or as needed. When staff (S1) was asked what happens when residents refuse showers, do they still change the linens? S1 stated that they do change the linens when the residents are out of their room. The LPA asked to see the linen closet for the facility, and it appeared that the facility had an adequate quantity of linens for the residents at the facility.
Although the allegation may have happened or is valid, based on the interviews, and observation, there is not sufficient evidence to prove the alleged violation did or did not occur.
Although the allegation may have happened or is valid, based on the interviews, and observation, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.
The facility has no means for residents to call for assistance.
On the allegation that the facility has no means for residents to call for assistance The RP states that the facility does not have a call system or means for residents to ask for help. The RP stated ‘if R1 needs to go to the bathroom or needs assistance, R1 has to wait for staff to check in’. The RP states that when they inquired with staff about a call system, they were told that staff check on residents every two hours. Furthermore, the RP stated that they were told that if they wanted R1 to have a call pendant they could buy / order one from Amazon. The RP stated that staff told RP what device to buy, but when the pendant arrived at the facility the staff never gave it to R1. The RP stated that when they followed up with staff about the pendant, the RP was told that a doctor's order is required to use the pendant. Continues on Pg. 6...
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 11
Control Number 29-AS-20230807152205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS
FACILITY NUMBER: 197609117
VISIT DATE: 12/12/2024
NARRATIVE
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Pg.6
To investigate the allegation LPA Urena conducted a tour of the facility along with the Regional Support Nurse (RSN). The LPA interviewed staff, RSN, and the Administrator. The tour of the facility revealed that each room has an alert signal system plate located inside the room by the door frame leading to the bathroom. The plate has a ‘PUSH’ sign to activate the system that sends a signal to the front desk and the Wellness Center staff, requesting assistance by the resident in the room. The RSN interview revealed that they were not aware the rooms had a call system. The staff interviews revealed that the alert signal system plate has been in place for some time. The staff interviewed, have been employed at the facility between one (1.7), four (4) and 16 years. Furthermore, the staff interviews of S1, S2, S4, revealed that once the system is activated by the residents, the signal will go to the front desk and the wellness center. Based on who receives the alert (the front desk or the wellness staff) will send a message to the caregiver/s via the telephone/radio each caregiver carries with them, and the caregiver(s) go to the resident’s room to give assistance to the resident. The current Administrator’s interview revealed that the system has been in place to their knowledge since they became the Administrator this year.

The LPA reviewed communication between the POA and the DHS dated 08/19/2023. The communication is via an email between the two parties: the DHS states, ‘The call button is next to R1’s bed, and the caregivers are aware of this, and to remind R1 use it to call for help/assistance. It is in R1’s room, and if it best to have R1 wear it around the neck, we can do so as well’. The LPA was unable to interview the ‘caregivers’ related to this communication as they could not be identified by name by the POA and the DHS is no longer working at the facility. The LPA interviewed the POA on 12/03/2024, per the POA they were not aware of the alert signal system plate, nor they were told about the system by staff, and consequently they purchased a call pendant for R1 based on the information provided by the DHS. On 12/11/2024, the LPA reviewed additional records, The records dated 07/17/2023, indicate that the facility’s Social Worker is communicating with the POA in regard to information about the call button to be purchased, which was being recommended by the DHS.

Although the POA was not made aware of the alert system by the facility staff, and the POA purchased a call pendant for R1, the facility had a call system in place at the time of the allegation. There is insufficient evidence to prove that the alert system was not functional at the time of the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Continues on Pg. 7
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 11
Control Number 29-AS-20230807152205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS
FACILITY NUMBER: 197609117
VISIT DATE: 12/12/2024
NARRATIVE
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Pg.7
Staff did not provide resident PRN medication as needed.
It is alleged that R1 staff is not providing R1 with PRN medication when requested by R1. The concern of the RP is that R1 is bedbound due to illness complications, and the illnesses are progressing, consequently R1 experiencing more pain. RP states that R1 has more pain, and when R1 asks staff for prescription Tylenol (PRN) they do not provide the medication to R1. To investigate the allegation LPA Urena conducted record review and interviewed the Administrator and the POA. Record review of the facility’s eMAR (Electronic Medication Administration Record) dated 07/01/2023 to 07/31/2023, revealed that R1 did not receive the PRN medication for the full month of July. The eMAR dated 08/01/2023 to 08/15/2023, revealed that R1 did not receive the PRN medication from 08/01/2023 to 08/15/2023. The PRN instructions are to dispense the medication as requested by the resident for pain. The eMAR dated 08/16/2023 was reviewed and it indicates that the new PRN medication was started on 08/15/2023 at bedtime and continued as indicated 2 times a day, once in the morning with breakfast and second dose at bedtime.

Although a PRN medication was prescribed prior to 08/15/2023, the prescription was that the medication was to be administered when requested by the resident. Per the POA the resident complained of pain, but resident did not know how to ask for the pain medication. Once this concern was brought up to R1’s physician, the prescription was changed to 2X per day. The facility provided the eMAR documenting the doses administered for the new prescription. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview was conducted, and a copy of the report was issued.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
08/07/2023 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20230807152205

FACILITY NAME:SILVERADO SENIOR LIVING - CALABASASFACILITY NUMBER:
197609117
ADMINISTRATOR:TERRI WEITZMANFACILITY TYPE:
740
ADDRESS:25100 CALABASAS RDTELEPHONE:
(818) 222-1000
CITY:CALABASASSTATE: CAZIP CODE:
91302
CAPACITY:110CENSUS: 45DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Patrice O'GradyTIME COMPLETED:
07:00 PM
ALLEGATION(S):
1
2
3
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5
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9
Staff did not safeguard resident's personal items.
Staff do not supervise resident when eating.
INVESTIGATION FINDINGS:
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12/12/2024, Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to investigate the allegations listed above. The LPA met with the Administrator Patrice O’Grady and explained the reason for the visit. The LPA requested additional records at 12:25 p.m.

On 08/15/2023, Licensing Program Analyst (LPA) Elsie Campos arrived unannounced to conduct an initial 10-day complaint visit. The LPA met with Administrator Terri Wheitzman and explained the reason for the visit.

Staff did not safeguard resident's personal items.
On the allegation that staff did not safeguard the residents’ personal items, it is the concern of the RP that staff took R1’s knee braces to be washed and never returned them. The RP states that they bought R1 a new pair of knee braces and they were also taken by staff, but never returned. To investigate the allegation LPA Urena conducted record review and staff interviews.
Continues on LIC9099 A(C)...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 8 of 11
Control Number 29-AS-20230807152205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS
FACILITY NUMBER: 197609117
VISIT DATE: 12/12/2024
NARRATIVE
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The record review of the Physician’s Order Review form dated August 15, 2023, indicates that R1’s physician ordered the knee braces to be put on both knees during the day and to be removed at bedtime. The staff’s interviews revealed that the residents’ personal items such as clothing does sometimes go missing, it may happen during the wash period. When the LPA asked staff (S1 and S2) about the process for the laundry, the staff stated that the clothes are collected from the residents’ rooms in bags and the bags are then taken to a room where the staff in charge of laundry collect the bags to take to the laundry room. The interview of S3 revealed that, ‘all residents clothing items are labeled with their name’. The residents’ clothes are washed mixed with other residents’ clothes. Clothes must be sorted after the wash and dry. The laundry staff return the clothes to the residents’ rooms. The RSN interview revealed that the residents’ responsible parties fill out a log with the personal belongings.’ The Administrator stated that because the residents’ room doors are kept open, sometimes other residents (with dementia) may take items. But, if an item is reported missing and cannot be located, the facility provides credit for the cost of the personal item.

Based on the information obtained through interviews and record review, the personal items of R1 were not safeguarded by staff. Therefore, the allegation is deemed Substantiated at this time.

Staff do not supervise resident when eating.
On the allegation that staff do not supervise resident when eating, it is the concern of the RP that R1 requires supervision when R1 eats, but the RP noticed during visits that R1 is sitting there (dining room) alone with their food. To investigate the allegation LPA Urena conducted record review. Medical records obtained by the LPA indicates that on 05/24/2023, R1 had a Neurology Outpatient visit and the medical provider notes indicate that R1 was accompanied by R1’s POA, facility Administrator Terri Weitzman, and a facility caregiver. Furthermore, the case notes indicate that at the time of the visit; it was noted that R1 had developed dysphagia (difficulty swallowing) to solid foods in early 2023, and the recommendation was to provide R1 with soft moistened solids, purees, thin liquids, and with direct staff supervision. On 06/02/2023, the POA communicated via email with the DHS to inform them that during a visit with R1, the POA observed that R1 had a plate of breakfast in their room, and the POA asked that R1 eat in the dining room where R1 could be supervised during meals.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 9 of 11
Control Number 29-AS-20230807152205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS
FACILITY NUMBER: 197609117
VISIT DATE: 12/12/2024
NARRATIVE
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Additional record review of medical records dated 07/12/2023 revealed that the facility received Diet Recommendations from the Speech Therapist at Rancho Los Amigos Rehabilitation Center on 07/12/2023. The recommendations indicate that R1 needs to receive a diet of puree foods, and nectar thick liquids. In addition to the diet recommendations, the medical document clearly states that “Close supervision to ensure patient takes 5-6 swallows per bite”. On 09/08/2023, the POA communicated via email with the DHS and two other facility staff about the concern of R1 not having breakfast and lunch meal during a recent doctor’s appointment, in which day, R1 returned late to the facility from the appointment, and the dining room was closed, consequently the R1 had to wait for dinner time. Per the POA a staff (name unknown) gave R1 chips and crackers to hold R1 over till dinner time.

Based on the information obtained trough record review and interviews, the facility the facility staff did not ensure R1 was supervised during mealtime, at all times. Therefore, the allegation is deemed Substantiated at this time.

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

Citations were issued Exit interview was conducted. A copy of the report and the Appeal Rights were provided.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 10 of 11
Control Number 29-AS-20230807152205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SILVERADO SENIOR LIVING - CALABASAS
FACILITY NUMBER: 197609117
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2025
Section Cited
HSC
1569.312(a)
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1569.312(a) Basic services requirements. Basic services shall at a minimum include: (a) Care and supervision as defined in Section 1569.2. This requirement is not met as evidenced by:
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Administartor will submit a plan how they will ensure appropriate care and supervision to meet the needs of residents. Submit to CCL by 1/10/2025.
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Based on interviews and records review, the licensee did not comply with the section cited above. Facility staff neglected to supervise R1 during meals, which posed a potential health and safety risk to residents in care.
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Type B
01/10/2025
Section Cited
CCR
87217(b)
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87217 (b) Safeguards for …Personal Property, and Valuables.
Every facility shall... safeguard residents'... personal property and valuables which have been entrusted...The licensee shall give the residents receipts for all... This requirement is not met as evidenced by:
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Administrator will submit a plan to properly safeguard residents' property as well as provide staff training regarding safeguarding residents' personal property. Submit to CCL by POC date.
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Based on interviews, the licensee did not comply with the section cited above as personal items of R1 went missing while in care, which posed a potential health, safety and personal rights risk to residents in care.
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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: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 11 of 11