198603267-9-30-2025-28-AS-WSHO-DMEU25-20251013151121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603267
Report Date: 09/30/2025
Date Signed: 09/30/2025 03:58:11 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/24/2025 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20250924093048

FACILITY NAME:	SILVERADO SENIOR LIVING-SIERRA VISTA		FACILITY NUMBER:	198603267
ADMINISTRATOR:	GWINN, VIDA		FACILITY TYPE:	740
ADDRESS:	125 E. SIERRA MADRE AVE		TELEPHONE:	(626) 812-9777
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	87	CENSUS: 65	DATE:	09/30/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Selene Rangel- DHS		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not meet incontinence care needs of residents.
Staff do not dispense medications as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation to investigate the above allegations. LPA met with Selene Rangel, DHS (Director of Health Services) and explained the purpose of the visit.

During this visit, LPA obtained a copy of the Resident and Staff rosters, obtained copies of relevant documentation, interviewed Staff 1 (S1) - Staff 7 (S7), Resident 1 (R1) - Resident 8 (R8). LPA also conducted a facility tour included med rooms.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

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 28-AS-20250924093048

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SILVERADO SENIOR LIVING-SIERRA VISTA	FACILITY NUMBER: 198603267
	VISIT DATE: 09/30/2025

NARRATIVE

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Allegation: Staff do not meet incontinence care needs of residents. It was alleged that staff do not meet incontinent care needs of the residents (they are forced to sit in diapers full of feces for more than an hour) due to lack of caregivers.

Interviewed staff denied the allegation. They stated that the facility has sufficient staff to meet all residents’ needs including incontinence residents. They stated that facility has enough staff to provide adequate care to residents in care. They assist residents with all their needs including diaper change. Facility has a 3-shift scheduled for morning, day, and night. They stated if there is a call off, they will replace the shift. It will be facility staff to work an extra shift, or facility will use staffing agencies to cover the shift. There are also student nurses on the floor almost every day. Interviewed staff stated that residents changed promptly, which is every 2 hours and as needed. If residents are soiled due to incontinence, they are changed right away. They are never forced to sit in diapers full of feces. LPA interviewed 8 residents of which 5 are incontinence. 4 residents stated the staff check their diapers often and change them as needed. 1 resident was unable to answer questions due to cognitive impairment. While LPA walked around to conduct resident interviews, LPA observed enough staff assisting residents. Also students from medical schools were present, assisting residents. Review of staff roster, daily staffing log, caregivers schedule and daily assignment sheet, indicates that the facility has sufficient staff to meet the needs of residents.

Allegation: Staff do not dispense medications as prescribed. It was alleged that staff do not dispense medications as prescribed. A capsule was observed on the floor and the medication cup with a pill left in it.

Interviewed staff denied the allegation. They stated that residents are receiving their medications as prescribed. Interviewed staff stated that medical staff dispense medication as prescribed. They stated that all nurses pass / administrate medications that are prescribed by doctor, there is no other way. Interviewed S1, S2 and S4 stated medications are popped up by LVN/ Med Tech before being administrated and given to residents by the staff who prepared the medication. If resident asks for medication to be left at his/her side that they can take independently, the staff / nurse will place the medication on the table in front of resident and remains at side of resident watching that resident swallow the medication. Staff does not walk away and leave the medication cup with a pill / medication in it. If they interrupted while popping medication, they will put the medication in the med. cart and lock it.

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SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250924093048

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SILVERADO SENIOR LIVING-SIERRA VISTA	FACILITY NUMBER: 198603267
	VISIT DATE: 09/30/2025

NARRATIVE

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Interviewed S1 mentioned that approximately one year ago they found Tylenol on the floor in one of resident room, the family member that was present stated the medication was theirs and that they had dropped it when taking their daily medication. This is the only case that happened at the facility. Interviewed S2 - S7 stated that they didn't notice / found any medication / capsule on the floor / residents room. Residents interviewed were unable to corroborate the allegation. LPA reviewed medications for 6 residents. Those are being locked in the med. carts, administered as prescribed and indicated on the electronic Medication Administration Record (MAR).

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.

Exit interview conducted and a report was provided to Selene Rangel- DHS.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

LIC9099 (FAS) - (06/04)

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