198603267-5-11-2022-28-AS-MVAO-CELTBP-20220520143529

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603267
Report Date: 05/11/2022
Date Signed: 05/11/2022 12:30:51 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
12/27/2021 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211227115456

FACILITY NAME:	SILVERADO SENIOR LIVING-SIERRA VISTA		FACILITY NUMBER:	198603267
ADMINISTRATOR:	GWINN, VIDA		FACILITY TYPE:	740
ADDRESS:	125 E. SIERRA MADRE AVE		TELEPHONE:	(949) 240-7200
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	87	CENSUS: 54	DATE:	05/11/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Selene Rangel; Director of Health Care Services		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident is denied visitations.
Resident is not allowed to receive confidential calls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegations. LPA met with Selene Rangel and explained the reason for the visit.

The investigaton consisted the following: during the initial visit conducted on 12/29/21, LPA Tao interviewed the Administrator and obtained copies of Resident & Staff Rosters. LPA Tao also obtained copies from Resident #1 (R1's) file such as Physician's Report, Progress Notes, Appraisal, and Visitor Policy. During today's visit, LPA interviewed Resident #1 (R1) - Resident #5 (R5) and Staff #1 (S1) - Staff #4 (S4).

The investigation revealed the following: in regards to the allegation "resident is denied visitations", it is alleged that on 12/26/21 facility staff denied visitation for R1. Interviews conducted with staff members denied the allegation. Staff members interviewed indicated that they are aware of resident rights regarding visitation and residents have the right to have visits from whomever they chose. Interview with R1 revealed that she doesn't recall the alleged incident that occurred on 12/26/21. R1 indicated it is possible that she wasn't feeling well and did not want to see any visitors on that day. (CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

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-20211227115456

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: 05/11/2022

NARRATIVE

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R1 indicated that she does want this individual to visit her and call her at the facility. LPA was provided a document signed by R1 indicating that she would like advanced notice prior to being visited by this certain individual. R1 confirmed that she is aware of this document and that she signed this document. LPA did not observe any documents or evidence in R1's file indicating that facility is restricting visitation from certain individuals. All residents interviewed indicated that they are allowed to have visitors of their choice during visiting hours and facility does not restrict their visitation rights. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation "resident is not allowed to receive confidential calls", it is alleged that facility staff deny phone calls from certain individuals for R1 unless a staff member is present to monitor the call. Interviews conducted with staff members denied this allegation. Staff members interviewed indicated that they do not monitor any resident calls. Staff members interviewed indicated that residents have the right to confidential calls and there are multiple phones available throughout the facility to make and/or receive confidential calls. LPA torued the facility and observed multiple working phones. All residents interviewed indicated that they are able to make and/or receive calls in private and without staff monitoring the calls. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or arevalid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

LIC9099 (FAS) - (06/04)

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