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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603266
Report Date: 08/02/2022
Date Signed: 08/02/2022 03:22:54 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/07/2022 and conducted by Evaluator Don Senaha
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220607093727
FACILITY NAME:SILVERADO SENIOR LIVING-BEVERLY PLACEFACILITY NUMBER:
198603266
ADMINISTRATOR:BELSON, MYLAFACILITY TYPE:
740
ADDRESS:330 N. HAYWORTH AVETELEPHONE:
(323) 852-9200
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:256CENSUS: 105DATE:
08/02/2022
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Administrator - Taylor GiuntoTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility does not provide a safe environment for residents in care.
Residents have sustained unexplained bruising while in care.
Facility staff do not have proper training.
INVESTIGATION FINDINGS:
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On 08/02/2022, Licensing Program Analyst (LPA) Don Senaha conducted a subsequent unannounced complaint visit to this facility for the allegations listed above. The purpose of this visit was to deliver the findings of the allegations listed above. Today’s complaint investigation was conducted with Administrator Taylor Giunto.

On 06/16/2022 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Administrator Taylor Giunto and Senior Director of Health Services Jean De Guzman.

The investigation consisted of the following: LPA requested resident roster, staff roster, physicians report, needs and service plans, ID/Emergency contact information, MARs, training documents and Admissions Agreements on 06/16/2022. LPA interviewed residents (R1-R11), witness (W1-W2) and staff (S1-S6).
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don SenahaTELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
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 3
Control Number 11-AS-20220607093727
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SILVERADO SENIOR LIVING-BEVERLY PLACE
FACILITY NUMBER: 198603266
VISIT DATE: 08/02/2022
NARRATIVE
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A plant inspection of the facility was conducted.

Investigation revealed:

Allegation: Facility does not provide a safe environment for residents in care.

During the course of the investigation, LPA was unable to find any witnesses, documentation or evidence supporting the allegation above. LPA interviewed residents (R1-R11) who did not express any concerns about a safe environment while in care. Staff (S1-S6) stated staff feels resident’s are given a comfortable living environment and the facility provides a safe environment for all residents in care. Witness (W2) is the conservator for R1 and stated W2 visits monthly and has no concerns about the safety for the resident. LPA reviewed training documents and did not observe the facility to have issues with safety during the plant inspection.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Residents have sustained unexplained bruising while in care.

It is alleged that residents have sustained unexplained bruising while in care.

During the course of the investigation, LPA was unable to find any witnesses, documentation or evidence supporting the allegation above. During interviews with residents (R1-R11), they did not express any concerns about sustaining any unexplained bruising while in care. Resident (R1-R11) had no issues with any staff helping them with their care. Staff (S1-S6) stated they have no apprehensions of residents who may sustain an unexplained bruise while in care. If a resident sustained an unexplained bruise while in care, staff would follow protocol and report to the nurse who would then document the unexplained bruising. Witness (W2) stated W2 has not had witnessed or seen any unexplained bruises on residents. LPA did not observe any resident’s with bruising upon interviews or plant inspection.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don SenahaTELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20220607093727
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SILVERADO SENIOR LIVING-BEVERLY PLACE
FACILITY NUMBER: 198603266
VISIT DATE: 08/02/2022
NARRATIVE
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Allegation: Facility staff do not have proper training.

It is alleged that the facility staff do not have proper training.

During the course of the investigation, LPA observed and reviewed a copy of the annual log book training for each month of the year. Administrator stated there is an “all staff” in service training every month with in person and videos on various topics. Administrator stated the training in the log book each year are similar in topics by month if not the same as the year prior. Staff (S2-S6) stated they have training every month which may include RN speaking, watching videos, computer, taking quizzes and receiving pamphlets of information. LPA obtained and reviewed copies of the training with staff signatures.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don SenahaTELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3