198603266-8-30-2024-11-AS-JHAD-D8U2L2-20240905172847

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603266
Report Date: 07/02/2024
Date Signed: 08/30/2024 12:30:24 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
09/01/2022 and conducted by Evaluator Sparkle Day

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220901144128

FACILITY NAME:	SILVERADO SENIOR LIVING-BEVERLY PLACE		FACILITY NUMBER:	198603266
ADMINISTRATOR:	GIUNTO, TAYLOR		FACILITY TYPE:	740
ADDRESS:	330 N. HAYWORTH AVE		TELEPHONE:	(323) 852-9200
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	256	CENSUS: 110	DATE:	07/02/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Stephanie Brynjoyfson, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff mishandled resident's medications
Facility is understaffed
Incomplete admission documents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sparkle Day conducted a “Subsequent” visit to ascertain additional information regarding the above-mentioned allegation(s) and for the purpose of rendering the findings. LPA met with Staff #1 Administrator,Stephanie Brynjoyfson who assisted with the visit.
The Investigation consisted of the following:

Regarding Allegation #1, FACILITY STAFF MISHANDLED RESIDENTS MEDICATIONS
It was alleged that the facility gave wrong medication to a resident. On 7/2/2024 at approximately 11:06am - 12:00pm LPA interviewed Resident #1- R#7. 7 out of 7 residents deny the allegation. Residents state medications are given timely daily and they have never been given the wrong medications. LPA interviewed Staff #1 - S#5 at approximately 11:30am - 12 :00 pm . 5 out 5 staff deny the allegation. Staff state medication is double checked by med tech and LVN prior to distribution of meds daily. LPA Day reviewed the medication Administration records and did not observe any discrepencies.
Based upon this investigation , LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle Day	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

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-20220901144128

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: 07/02/2024

NARRATIVE

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Regarding Allegation #2, FACILITY IS UNDERSTAFFED
It was alleged that there is a staffing problem on the 3rd floor of the facility. On 7/2/2024 at approximately 11:06 LPA interviewed Resident #1- R#7. 7 out of 7 residents deny the allegation. Residents state there is always enough staff on the 3rd floor to meet their needs. LPA interviewed Staff #1 - S#5. 5 out 5 staff deny the allegation. Staff state the 3rd floor is the LOFT where the residents are pretty independent and don't require alot of care, however staff are always there to assist and supervise residents. LPA toured the 3rd floor (The Loft) and found the residents are independent and don't require much assistance. LPA observed that there is a 1 -7 staff to resident ratio on the 1st floor, A 1-6 staff to resident ratio on the 2nd floor and 1 - 6 staff to resident ratio on the 3rd floor. All floors have a 5 staff standby resident assistance if needed.

Based upon this investigation , LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED].

Regarding Allegation #3- Incomplete Admission documents
It was alleged that the facility is not giving residents or residents' families all necessary documents during admission. 0n 7/2/2024 at around 11:50 am LPA interviewed Staff #1 - S#5 regarding the allegation. 5 out of 5 staff deny the allegations. Staff state that all residents and/or residents families are given a copy of their admission documents at time of admission with their signatures. Staff informed LPA that residents have a choice of receiving a paper packet of their signed admission documents or they can get their documents Docu Sign, in which the documents are emailed to them with their signatures. LPA interviewed Resident #1 - R#7 regarding this allegation. 5 out of 7 residents deny the allegation and state they were given copies of everything signed at admission. The other 2 residents do not recall.

Based upon this investigation , LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with A copy of this report was left with

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle Day	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC9099 (FAS) - (06/04)

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