198603266-1-26-2026-11-AS-JHAD-DTRQBU-20260504120201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603266
Report Date: 01/26/2026
Date Signed: 01/26/2026 04:39:05 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/21/2026 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260121153025

FACILITY NAME:	SILVERADO SENIOR LIVING-BEVERLY PLACE		FACILITY NUMBER:	198603266
ADMINISTRATOR:	GIUNTO,TAYLOR L.		FACILITY TYPE:	740
ADDRESS:	330 N. HAYWORTH AVE		TELEPHONE:	(323) 852-9200
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	256	CENSUS: 113	DATE:	01/26/2026
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Stephanie Brynjolfson		TIME COMPLETED:	02:29 PM

ALLEGATION(S):

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Staff did not adequately supervise resident in care resulting in resident eloping from the facility.

INVESTIGATION FINDINGS:

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On January 26, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit. Stephanie Brynjolfson admnistrator a greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegation mentioned above.

The investigation included interviews, record reviews, and a tour of the facility. Interviews with Staff member #1 (S1) and Resident #1(R1) . The Department reviewed several documents, including the Facility Resident Roster (dated 01/22/26), the Personnel Report LIC 500 (dated 01/21/26), (R1's) Physician’s Report LIC 602A (dated 9/11/26), the Preplacement Appraisal Information LIC 603 (dated 09/10/25), Unusual Incident Report LIC 624 (dated 01/24/26), Facility Surevillance Camera Footage (dated 01/18/26), and other pertinent records associated with this complaint.

(Evaluation Report continues LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

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 11-AS-20260121153025

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SILVERADO SENIOR LIVING-BEVERLY PLACE	FACILITY NUMBER: 198603266
	VISIT DATE: 01/26/2026

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff did not adequately supervise resident in care resulting in resident eloping from the facility.

It is alleged that the facility staff failed to adequately supervise Resident #1 (R1), resulting in (R1) leaving the facility without permission. Reports indicate that (R1) exited the facility unattended around 12:30 PM on Sunday, January 18, 2026. No further details regarding this incident were provided.

On January 26, 2026, between 11:50 AM and 12:00 PM, the Department interviewed with a staff member referred to as Staff #1 (S1). During the interview, (S1) confirmed that on Sunday, January 18, 2026, at approximately 12:36 PM, Resident #1 (R1) left the facility unaccompanied.

Video footage from that day shows (R1), who resides in room #345 on the third floor, taking the elevator down to the basement level of the garage. (R1) exited through the fire exit door, which was supposed to remain unlocked under City Fire Department regulations, and walked out onto Hayworth Avenue.

(S1) explained that the video showed a visitor pressing the elevator call button in the garage while (R1) was inside the elevator. When the elevator doors opened for the visitor, (R1) exited the elevator and left the facility through the fire door. (S1) indicated that, at the time of the incident, the facility had three care staff members working on the third floor and front desk staff monitoring the surveillance security displays. Despite this, (R1) still managed to leave the facility.

On January 26, 2026, between 11:00 AM and 11:23 PM, the Department interviewed a resident identified as Resident #1 (R1). During the interview, (R1) recalled leaving the facility unaccompanied but could not recall the exact date and time of the incident. (R1) demonstrated step by step how to call the elevator. (R1) pressed the elevator call button on the third floor and walked in, then pushed the close button. When the elevator doors closed, (R1) waited for the elevator to move, but movement would not occur without entering a code or selecting another floor. (R1) did not proceed to activate any buttons. The elevator was then summoned to the basement garage, and (R1) also showed how to exit the facility through the fire exit door.

The Department reviewed the video footage of the incident that occurred on January 18, 2026. The review confirmed the information provided by (S1) that the visitor summoned the elevator at the garage level, which then summoned the elevator car.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260121153025

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SILVERADO SENIOR LIVING-BEVERLY PLACE	FACILITY NUMBER: 198603266
	VISIT DATE: 01/26/2026

NARRATIVE

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The footage showed that (R1) exited the elevator and appeared to wander out, looking apprehensive and disoriented. Further analysis of the Unusual Incident Report LIC 624 (dated January 24, 2026) and the Physician's Report LIC 602A (dated September 11, 2025) revealed that (R1) exhibited unsafe wandering behavior and signs of sundowning. Preplacement assessment Information LIC 603 (dated September 10, 2025) (R1) requires special observation/night supervision due to confusion, forgetfulness, and wandering.

Based on the information gathered, there is sufficient evidence to support the allegation mentioned above.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency were observed, and citation issued (ref. LIC 9099 D).

An exit interview was conducted with Stephanie Brynjolfson, and copies of the report and appeal rights were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260121153025

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SILVERADO SENIOR LIVING-BEVERLY PLACE	FACILITY NUMBER: 198603266
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/09/2026 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General (a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required...	1 2 3 4 5 6 7	Licensee will adhere to the regulations and ensure review of Title 22, Section 87411. The Licensee will develop a Plan to address and resolve the security and safety issues related to (NCD) wandering and elopement behaviors—proof of correction to be sent by fax to the El Segundo Regional office at 424-544-1016 by 02/09/26.
	8 9 10 11 12 13 14	This requirement is not met as evidence by: Based on interviews and record reviews, the Licensee failed to provide necessary supervision services to meet resident needs and eloped from the facility unsupervised. This violation possesses a potential Health and Safety risk to residents in care.	8 9 10 11 12 13 14	Immediate Civil Penalty Issued.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC9099 (FAS) - (06/04)

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