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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609117
Report Date: 01/16/2025
Date Signed: 01/16/2025 02:55:59 PM

Document Has Been Signed on 01/16/2025 02:55 PM - It Cannot Be Edited

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 - CALABASASFACILITY NUMBER:
197609117
ADMINISTRATOR/
DIRECTOR:
PATRICE O'GRADYFACILITY TYPE:
740
ADDRESS:25100 CALABASAS RDTELEPHONE:
(818) 222-1000
CITY:CALABASASSTATE: CAZIP CODE:
91302
CAPACITY: 110TOTAL ENROLLED CHILDREN: 0CENSUS: 46DATE:
01/16/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:26 AM
MET WITH:Laken LacyTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Kelly Dulek conducted a Case Management - Incident visit regarding a self-reported incident. LPA met with Regional Nurse Specialist Laken Lacy and explained the reason for the visit.

A self-reported incident related to Resident #1 (R1) was received in the Woodland Hills Regional Office on 12/27/2024. Incident Report indicates "noted with an abrasion to R1's right knee. Injury obtained during transfer." LPA called the facility to inquire the circumstances surrounding the transfer and requested additional documents to be faxed to the Woodland Hills Regional Office, which were received on 12/31/2024.

During LPA's visit today, LPA interviewed Regional Nurse Specialist beginning at 10:37AM, toured the facility with Regional Nurse Specialist at 01:19PM and LPA obtained copies of pertinent documents. No immediate health and safety hazards were identified during facility tour. Interview and document review revealed that R1 had previously undergone right knee replacement prior to R1 moving into the facility. Interview with Regional Nurse Specialist revealed that R1 does require transfer assistance and on 12/22/2024, an agency staff was assisting R1 with transferring between wheelchair and bed when R1's right knee bumped the wheelchair. R1 was observed with a small abrasion but did not report nor appear to be in any pain at that time. The following day, R1 appeared to be in pain, so R1 was sent to the hospital for additional medical attention. Hospital records reviewed indicate "apparent fracture of the distal femur above the site of the prosthesis." R1 returned to the facility with a knee immobilizer and pain medication. Follow up was scheduled with orthopedic specialist on 01/16/2025. Records reviewed do not indicate the injury is acute, nor do records indicate the fracture was sustained as a result of improper transfer or that the injury occurred due to lack of care and supervision. Based on the information obtained there is insufficient evidence to determine whether lack of care and/or supervision contributed to the injury R1 sustained.

No deficiencies cited during today's visit. Exit interview conducted. A copy of the report was provided.
Kristin HeffernanTELEPHONE: (818) 596-4493
Kelly DulekTELEPHONE: (951) 836-3170
DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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