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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603267
Report Date: 10/24/2023
Date Signed: 10/24/2023 01:29:45 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
10/19/2023 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20231019092218
FACILITY NAME:SILVERADO SENIOR LIVING-SIERRA VISTAFACILITY NUMBER:
198603267
ADMINISTRATOR:GWINN, VIDAFACILITY TYPE:
740
ADDRESS:125 E. SIERRA MADRE AVETELEPHONE:
(949) 240-7200
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY:87CENSUS: 59DATE:
10/24/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH: Rangel-Gutierrez SeleneTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are not ensuring residents are receiving their phone calls.
Facility is not ensuring adequate staffing.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced 10 day complaint visit to investigate the allegations listed above. Upon arriving at the facility, LPA met Rangel-Gutierrez Selene DHS who assisted with the visit. The reason for the visit was explained.

The investigation consisted of the following: LPA Margaryan toured the facility, obtained a copies of the staff roster, residents roster. LPA Margaryan also obtained copies of documents pertaining to Resident#1 (R1) including notes from staff in regards to R1's phone calls. LPA interviewed Staff#1 - Staff #5 (S #1 - S #5) and Resident #1 - Resident #6 (R #1 - R #6).

Cont. 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
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 3
Control Number 28-AS-20231019092218
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: 10/24/2023
NARRATIVE
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Allegation: Staff are not ensuring residents are receiving their phone calls. It was alleged that unknown staff told caller that R #1 either busy, napping or only has one caregiver and is unable to go get him the phone.

Staff interviews were conducted. Per staff interviews, staff are ensuring that residents are receiving phone calls. Per staff interviews, most residents residing at this facility do not use the telephone often due to their dementia and/or family involvement. Interviewed staff reported its residents personal right to use the facility phones any time, receiving or making calls. Staff stated when residents are receiving a phone calls, staff is locating the residents and they can speak on the phone to the caller. In case of residents are taking naps, resting or at the time of meals, they will ask caller, call residents back and taking massages, asking call back number. But most of the time residents are taking calls after staff transferring calls to them. Interviewed staff stated that facility has a total 13 phones available for residents to use: 7 land lines and 6 cell phones. During the facility tour LPA observed Telephones / land lines are located in Reception area, Wellness CT-CV, Wellness CT-TP, Middle Canyon View, Upstairs TP Tuscany, TP Dinning Room, Back- Social Worker Office and Cell phones in Reception area, CV Nurse office (2) , TP nurse office (2) and Unit Secretary phone. Interviewed staff stated when R1 received phone calls from the family members staff always transfer calls to R1. When R1 is napping , participating in activities or eating meals staff will ask callers call back. LPA obtained and reviewed staff notes regarding R1 calls received past few days: 10/19/23, 10/22/23, 10/23/23. Staff stated sometimes callers waiting on the line a few minutes until staff locating the residents, and they don't like it. During today’s visit, LPA interviewed R#1 - R #6. Resident interviews revealed that residents are receiving phone calls. Interviews conducted do not corroborate this allegation.

Cont. 9099C

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20231019092218
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: 10/24/2023
NARRATIVE
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Allegation: Facility is not ensuring adequate staffing. It was alleged that there is one caregiver and is unable to get Resident #1 the phone.

Interviewed staff denied the allegation. They stated that Facility has enough staff. Staff stated that there is a paging system / walkie - talkie to page the staff to locate the residents. S3 or other staff never told the caller there is a only one caregiver and is unable to get R #1. When R1 or other residents are receiving calls from the family members, staff always transfer calls to R1 or other residents. Staff stated that not only caregivers are locating residents to get a calls. All staff at the facility have walkie- talkies and can hear the page. Staff who is available/has a cell phones will assist residents with the calls.

Based on documents reviews, observation and interviews, 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, and a copy of this report was provided to Rangel-Gutierrez Selene Director of Health Care Services.

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3