198603266-11-10-2024-11-AS-JHAD-DB2VV5-20241115154543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603266
Report Date: 11/10/2024
Date Signed: 11/10/2024 09:30:20 PM

Unsubstantiated

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
12/19/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231219112612

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: 111	DATE:	11/10/2024
		UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	Krystal Miloservic		TIME COMPLETED:	04:43 PM

ALLEGATION(S):

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Staff handles residents in a rough manner.
Staff did not ensure that a resident's incontinence needs were met.
Staff do not ensure that residents' dietary needs are met.
Staff do not monitor residents for change in condition.
Staff did not provide resident with clean linen.
Staff did not report incident to appropriate parties.

INVESTIGATION FINDINGS:

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On 11/10/24, California Department of Social Services/Community Care Licensing (CDSS/CCL) associate conducted a subsequent unannounced complaint visit. (CDSS/CCL) associate was greeted by Director of Resident & Family Services Krystal Milosevic. (CDSS/CCL) associate explained the purpose of this visit was to deliver findings for the allegations mentioned in this complaint.

The investigation consisted of the following: An initial complaint investigation/health and safety visit on 12/26/23, interviews, and collection of records. Interviews with Staff #1-#5 (S1-S5), Residents #1-#10 (R1-R10) and Witness #1 (W1). review of Personnel Report LIC 500 (dated: 12/26/23), Registered of Faciltiy Resident Roster (dated: 12/26/23),Service Plan (dated: 09/09/23 & 12/18/23), Physician Report LIC 624A (dated: 02/16/23), Incident Report LIC 624 (dated: 12/22/23), Facility NOC Resident Assignment/Resident Care Schedule (dated: 12/01/23-12/19/23), and Caregiver Daily Rounds Schedule (dated: 12/01/23-12/19/23), Resident’s Dietary Report (dated: 12/26/23), and email correspondences (dated: 12/18/24). (Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2024

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 6

Control Number 11-AS-20231219112612

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: 11/10/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff handles residents in a rough manner.

The details of the complaint alleged that staff handled (R1) in a rough manner. It is reported that staff #3-#4 were involved in an incident with (R1) on 12/17/23, where (R1) fell and sustained a left arm injury. Further details provided the incident took place during (R1’s) vital checks was taking place and that (R1) became unsettled and aggressive and that (S4) pushed (R1) down causing a fall and sustained injury.

On 12/26/23, between 01:30 pm – 04: 00 pm, the Department interviewed (2) out of (3) who claimed this accusation was false. (S1) stated that an investigation on this matter concluded and no findings of abuse were found. (S1) described on an Incident Report LIC 624 (dated: 12/22/24), that (R1) was restless and aggressive with (S4), and a body movement with (R1) caused (R1) to lose balance and fall back. (S1) indicated (S3 and S4) interviews resulted in no negative feedback on care concerns or work performance about (S3). (S3) claimed to have not been observed how (R1) fell. (S3) claimed that staff #4-#5 (S4-S5) were both assisting (R1) on 12/17/24 when the fall incident took place. (S5) reported the incident to (S3) in which (S5) provided inconsistent times when the incident occurred. (S3) claimed that there were tensions between (S4 and S5) and did not get along and may have given inaccurate reporting of what occurred. (S3) assessed (R1) and noted a skin tear on the lower left arm due to the range of motion and found no head injury. (S3) stated first aid treatment was administered for the skin tear. (S4 and S5) were not available for an interview or comments on this matter.

On 12/26/23, between 10:00 am – 01:00 the Department interviewed (7) out of (10) residents could not corroborate this allegation. Seven (7) out of ten(10) residents stated the facility staff provided acceptable services, complimentary, and had not experienced any mistreatment. (R9-R10) refused to be part in an interview.

As a result of the Department reviewing (R1’s) Service Plan (09/09/23 & 12/18/23), Physician Report LIC 624A (dated: 02/16/23), Incident Report LIC 624 (dated: 12/22/24), revealed that (R1’s) mental condition is associated with behavior disturbance, anxiety, depression, sundowning, and a fall risk. Based on the gathered information, there is not enough evidence to support the allegation mentioned above.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 11-AS-20231219112612

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: 11/10/2024

NARRATIVE

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Allegation #2: Staff did not ensure that a resident’s incontinence needs were met.
Allegation #4: Staff do not monitor residents for change in condition.

The details of this complaint alleged that staff do not ensure resident #1 (R1) incontinence needs are met. Information provided claimed that (R1) is not being checked every two hours or checked throughout night hours for diaper changes. This coincides with a report that staff do not monitor residents' changes in condition due to incontinent services.

On 12/26/23, between 01:30 pm – 04: 00 pm, the Department interviewed (2) out of (3) staff #1-#3 who claimed this accusation was false. (S3) claimed to have experienced that when resident refuses service the staff will send a new face, and they will accept our assistance. (S3) stated that (R1) is often upset and refuses the staff to assist with (R1’s) toileting needs. The staff would often send new faces that (R1) is familiar with and will allow for assistance. According to (S3), the residents are not in the right frame of mind and do not want to be groomed or not feeling well. As soon as they tell me they feel dizzy, I will take their vital signs to ensure everything is okay. Residents' hydration is monitored and assisted by caregivers. I look at their color, their lips, and their skin. If they appear to be dry, they need more liquids. For instance, if residents show elevated blood pressure, that's the first sign of dehydration. (S4 and S5) were unavailable for an interview or comments on this matter.

On 12/26/23, between 10:00 am – 01: 00 pm, the Department interviewed (7) out of (10) residents could not corroborate this allegation. Seven out of ten (10) stated the facility staff provided adequate incontinent services or had no issues. Seven (7) out of ten (10) claimed the staff do monitor their change in condition and had no concerns on this matter. (R9-R10) refused to take part in an interview.

As a result of the Department reviewing (R1’s) Service Plan (dated: 09/09/23 & 12/18/23), Physician Report LIC 624A (dated: 02/16/23), Incident Report LIC 624 (dated: 12/22/23), Facility NOC Resident Assignment/Resident Care Schedule (dated: 12/01/23-12/19/23), and Caregiver Daily Rounds Schedule (dated: 12/01/23-12/19/23), revealed that (R1’s) required assistance with toileting. However, (R1) did not require continuous bed care, had no history of skin condition or breakdown, and monitoring, repositioning, and diaper changes were performed on (R1). Based on the gathered information, there is insufficient evidence to support the allegation mentioned above.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 11-AS-20231219112612

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: 11/10/2024

NARRATIVE

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Allegation #3: Staff do not ensure that resident’s dietary needs are met.

A resident's diet was allegedly not provided according to the details of this complaint. It is reported residents are not provided with water or snacks. They were no further detailed information on this matter.

On 12/26/23, between 10:00 am – 01:00 pm, the Department interviewed (7) out of (10) residents could not support this allegation. Seven (7) out of ten (10) were complimentary of the food and claimed it was pleasing, and ample refreshments and snacks were offered throughout the day. Two (2) out of ten (10) residents claimed to be on a special diet and that their dietary needs were fulfilled. (R9-R10) did not want to take part in an interview.

On 12/26/23, between 01:30 pm – 04: 00 pm, the Department interviewed (2) out of (3) staff who claimed this allegation is untrue. (S3) stated most of the residents are on a mechanical so diet, while some are on puree. The kitchen creates individual special orders for those on special diets as well according to their care plan. (S3) reported that plentiful water and snacks are provided during mealtimes.

As a result of the Department reviewing (R1’s) Service Plan (dated: 09/09/23 & 12/18/23), Physician Report LIC 624A (dated: 02/16/23) and Resident’s Dietary Report (dated: 12/26/23), revealed that (R1) was not on any special diet and no medical history of due to dehydration or malnourishment. Based on the gathered information, there is insufficient evidence to corroborate the allegation mentioned above.

Allegation #5: Staff did not provide resident with clean linen.

The detail of this complaint alleged that staff do not provide residents with clean linen. It is reported due to the abundant of incontinent activities, the residents are not provided with clean linens. There were no further details on this matter provided.

On 12/26/23, between 01:30 pm – 04: 00 pm the Department (2) ou of (3) staff who claimed this accusation was fabricated. (S3) claimed the caregivers have a schedule of linens. We don't wash that with their personal clothing as sometimes people do have accidents. There are ample linens provided to our residents in care. Linens are provided daily or as needed to residents according to (S3).

On 12/26/23, between 10:00 am – 01: 00 pm, the Department interviewed (7) out of (10) residents. could not attest this allegation. Seven (7) out of ten (10) stated that linens are changed regularly or had no concerns on this matter. (R9-R10) refused to take part in an interview.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 11-AS-20231219112612

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: 11/10/2024

NARRATIVE

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As a result of the department observation during the investigation on 12/26/23, the Department observed storage closets filled linens, and the linens observed appeared to be clean and presentable. Based on the gathered information, there is insufficient evidence to corroborate the allegation mentioned above.

Allegation #6: Staff did not report incident to appropriate parties.

The details for this complaint alleged the incident with resident #1 (R1) on 12/17/24 was not reported to the appropriate parties. The reports claimed the (R1’s) family was provided false information on (R1’s) fall incident and gave inaccurate information on how (R1) sustained the arm injury.

On 12/26/23, between 01:30 pm – 04: 00 pm the Department interviewed (2) out of (3) staff claimed this accusation was false. (S3) stated in general when an incident occurs, after we handle the situation, the nurse on call, will dispatch for assistance to call 911. Paramedics arrive and I provide them with paperwork. I inform the responsible parties by telephone. I provide written information to (S1) and it is cross reported to authorized parties. (S1) claimed the incident was reported in an Incident Report LIC 624 (dated: 12/22/24) to authorized representatives appropriately.

On 12/26/23, between 10:00 am – 01: 00 pm the Department interviewed (7) out of (10) residents could not validate this allegation. Seven (7) out of ten (10) stated the facility followed proper protocol and reports to authorized representatives. (R9-R10) refused to take part in an interview.

As a result of the Department reviewing (R1’s) Incident Report LIC 624 (dated: 12/22/24 and the facility’s email correspondences (dated: 12/18/24) revealed incident involving (R1) was discussed, investigated, and reported to (R1’s) authorized representatives. Based on the gathered information, there is insufficient evidence to corroborate the allegation mentioned above.

Between 12/26/24 - 01/10/24, the Department attempted to interview family representative witness #1 (W1) of (R1) by telephone who were unavailable for statements.

Between 12/26/24 - 01/10/24, the Department made several attempts to interview staff #4 and #5 by telephone and were unavailable for comments.

Due to the resident's passing on 12/23/23, the Department was not able to obtain statements from Resident #1 (R1).

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 11-AS-20231219112612

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: 11/10/2024

NARRATIVE

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Based on information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Director of Resident & Family Services, Krystal Milosevic, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2024

LIC9099 (FAS) - (06/04)

Page: 6 of 6