198603266-4-14-2025-11-AS-JHAD-DFZSM4-20250423135920

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603266
Report Date: 04/14/2025
Date Signed: 04/14/2025 08:48:54 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
04/07/2025 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250407092804

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: 115	DATE:	04/14/2025
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Stephanie Brynjolfson		TIME COMPLETED:	11:56 AM

ALLEGATION(S):

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Staff behavior poses as a risk to a resident while in care.
Staff forced a resident to take medication while in care.

INVESTIGATION FINDINGS:

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On April 14, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a visit to gather information regarding the above allegations. LPA met with Stephanie Brynjolfson the Executive Director, and explained the purpose of the visit. LPA was granted entry to the facility.

The investigation consisted of Interviews, a collection of records, and a tour of the facility. Interviews were conducted with staff members #1 to #6 (S1-S6), resident members #1 to #10 (R1-R10) and witnesses #1 to #2 (W1-W2). List of documents reviewed/obtained Resident Roster (dated 04/09/25), Personnel Report LIC 500 (dated 04/09/25), (R1)'s Physicians Report LIC 602A (dated 02/21/25), Resident Appraisal (dated 02/17/25), Identification and Emergency Information LIC 601 (dated 02/27/25), and other pertinent documents associated with this complaint.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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-20250407092804

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: 04/14/2025

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff behavior poses as a risk to a resident while in care.

Allegation #2: Staff forced a resident to take medication while in care.
The complaint alleges that the facility staff is unkind and forces Resident #1 (R1) to take medication without informing (R1). As a result of these issues, (R1) feels uncomfortable at the facility. No additional information was provided regarding these allegations.

A review of Resident #1 (R1)’s identification and Emergency Information, (dated 02/27/25), indicates that (R1) was admitted to Silverado Senior Living Beverly Place (SSLBP) on that date. Previously, (R1) resided at Belmont Village Westwood from August 2024 to September 2024 and lived independently in a senior living community from November 2024 until February 2025.

During (R1)’s time at (SSLBP), several medical visits occurred on March 23, 29, April 1, and April 4, 2025. Three of these four visits were related to the treatment of mental health condition.

On April 9, 2025, between 1:15 PM and 2:45 PM, the Department interviewed resident members identified as Resident #1 through Resident #10 (R1-R10). Ten (10) out of the (10) were unable to validate these allegations. (R1) asserted that the conduct of the staff did not present any risk and emphasized that no staff member ever coerced (R1) into taking medications against (R1)'s will. (R1) noted that the staff are kind and attentive, explains the medications, ensure understanding, and encourages questions. (R1) expressed that the feelings of despair stem from the challenges of adapting to assisted living, which significantly diminishes (R1)'s sense of independence and has nothing to do with staff’s behavior. (R2-R10) expressed appreciation for the staff and reported no issues with medication administration.

On April 9, 2025, between 9:45 AM and 3:15 PM, the Department interviewed staff members identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to corroborate these allegations. Staff members (S1-S6) reported no issues with the behavior of staff or the way medications are given to (R1). (S4-S6) noted that (R1) asks questions about the medications but has never been forced to take or refuse them. (S1-S3) mentioned that (R1) is adjusting from independent to assisted living environment. It was also noted that (R1) was admitted to Cedar Sinai on April 4, 2025, due to experiencing emotional distress. (S1-S6) confirmed that all staff have received Workplace Sensitivity and Medication Administration training to handle these situations appropriately.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250407092804

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: 04/14/2025

NARRATIVE

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On April 9, 2025, between 11:45 AM and 12:35 PM, the Department interviewed witness members identified as Witness #1 and Witness #2 (W1-W2). Two (2) out of the (2) witness members were not able to verify these allegations. (W1) the Executive Director at Belmont Village Westwood, characterized (R1) as both cooperative and inquisitive regarding medication administration. (W2) a power of attorney for (R1), indicated that (R1) is presently assessing the suitability of assisted living concerning (R1)'s lifestyle needs that may have some reasons for (R1) emotional distress.

The Department reviewed Resident #1 (R1) 's Physicians Report LIC 602A (dated 02/21/25) and Resident Appraisal (dated 02/17/25) revealed that (R1) is diagnosed with a mental disorder. Further review of (R1) Physician Order Medication Review (dated 03/23/25 and 04/01/25) and PRN Authorization Letter (dated 02/27/25) identified (R1) cannot determine own need for prescription or nonprescription medications and requires assistance with administration of drugs. (R1) is prescribed eighteen (18) prescription combined prescription and nonprescription medicines and is being treated for (R1) 's mental condition. Twelve (12) of the eighteen (18) medications have adverse side effects or negatively affect (R1) 's mental status (ref: National Institutes of Health - NIH).

An additional review of staff training records verified staff had completed Workplace Sensitivity Training Courses, including ADLs and Behaviors, Psychosocial Needs, Challenging Behaviors, Basic Essentials, Person Center Care and Medication Management.

During the visit on April 4 and 14, 2025, the Department identified that the facility promotes the rights of its residents. To improve the environment, posters outlining Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster were displayed prominently throughout the facility.

Based on the information gathered, there is not enough evidence to support the allegations mentioned above.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. While the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegations are determined Unsubstantiated.

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

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

LIC9099 (FAS) - (06/04)

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