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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603266
Report Date: 02/12/2026
Date Signed: 02/12/2026 10:10:42 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 PLACEFACILITY NUMBER:
198603266
ADMINISTRATOR:GIUNTO,TAYLOR L.FACILITY TYPE:
740
ADDRESS:330 N. HAYWORTH AVETELEPHONE:
(323) 852-9200
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:256CENSUS: 114DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
08:12 AM
MET WITH:Stephanie Brynjolfson & Ana Maria DiazTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not adequately supervise resident in care resulting in resident sustaining injuries.
INVESTIGATION FINDINGS:
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On February 12, 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 and Ana Maria Diaz Assistant Director of Health Services 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 S#1 - S#6 (S1-S6) and Resident #2 - #10 (R2- R10). 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: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
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 5
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: 02/12/2026
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #2: Staff did not adequately supervise resident in care resulting in resident sustaining injuries.
It is alleged that Resident #1 (R1) sustained injuries due to inadequate supervision by staff. On January 18, 2026, (R1) reportedly eloped from the facility without staff supervision and sustained injuries. Upon (R1's) return to the facility, nursing staff evaluated (R1) and observed skinned knees, swollen palms, and bruising. This indicates that (R1) wandered out into the community unsupervised and likely fell at some point during the elopement. No further details regarding this incident were provided.

On January 26, 2026, and February 12, 2026, between 11:50 AM and 01:00 PM, the Department interviewed with staff members identified as Staff #1 through Staff #6 (S1-S6). Five (5) out of the six (6) staff members were able to validate this claim that (R1) sustained injuries during an elopement from the facility. During the interview, staff members (S1-S5) confirmed that on Sunday, January 18, 2026, at approximately 12:36 PM, Resident #1 (R1) left the facility unaccompanied. Upon returning, (R1) sustained injuries to the knee and palm. Photography of the injuries was shown and confirmed that they occurred during the elopement and not before according to (S1-S5). Based on information from (S1-S5), it was determined that individual (R1) received first-aid care following the fall. (R1) did not require hospitalization and did not sustained any fractures as a result of the incident.

On January 26, 2026, between 11:00 AM and 11:23 AM, the Department interviewed a resident identified as Resident #1 (R1). During the interview, R1 recalled leaving the facility alone but could not remember what happened afterward.



The Department reviewed video footage from that day, which shows (R1), who resides in room #345 on the third floor, taking the elevator down to the garage's basement level. (R1) exited through the fire exit door unassisted by staff, and walked out onto Hayworth Avenue. Further review of the Unusual Incident/Injury Report LIC 624 (dated 01/24/26) verified (R1's) unassisted elopement with injuries. Further review of (R1's) Physician's Report for Residential Care Facilities for the Elderly LIC 602A (dated 09/11/25) (R1) has been assessed, and it is noted that allowing to leave the community unsupervised may present risks related to (R1's) health and mental well-being.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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: 02/12/2026
NARRATIVE
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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.



*Immediate Civil Penalty issued*

ECP: At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(f) For a violation that the department determines constitutes physical abuse, as defined in Section 15610.63 of the Welfare and Institutions Code, or resulted in serious bodily injury, as defined in Section 15610.67 of the Welfare and Institutions Code, to a resident, the civil penalty shall be ten thousand dollars ($10,000).

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
02/12/2026
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all... (2) To be accorded safe, healthful and comfortable accommodations...

This requirement is not met as evidenced by:
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Licensee/Administrator shall ensure that all staff are trained on elopment and reduce fall injuries resident-specific care plans. The facility will review and update (R1’s) care plan and implement measures to reduce future falls. Documentation of staff training and care plan updates will be submitted to the Department by 02/13/25 to ernand.dabuet@dss.ca.gov
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Based on interviews, observation, and record reviews, the Licensee failed to adequately supervise (R1) on 01/18/26, who eloped from the facility and sustained injuries during the elopement. This violation poses an immediate health and safety risk to residents in care.
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**IMMEDIATE CIVIL PENALTY***
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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.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5