198603267-4-22-2022-28-AS-SCOL-CFSUGE-20220627153411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603267
Report Date: 04/22/2022
Date Signed: 04/22/2022 04:09:08 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
04/12/2022 and conducted by Evaluator Nune Margaryan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220412094959

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: 53	DATE:	04/22/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Almavida Gwinn Administrator and Rangel-Gutierrez Selene DHS		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility is unkempt
Facility is malodorous
Facility has infestation of bugs
Facility failed to provide residents with clean linens

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 with Administrator Almavida Gwinn and Rangel-Gutierrez Selene DHS who assisted with the visit. The reason for the visit was explained.

The investigation consisted of the following: LPA Margaryan inspected the facility including residents’ rooms, tested the signal system, obtained a copies of the staff roster, residents roster, other relevant documents and interviewed Administrator, Staff ( S1) to Staff 6 (S6) and Resident 2 (R2) to Resident 6 (R6). LPA was not able to interview Resident 1 (R1) because R1 moved from the facility on 03/25/22.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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-20220412094959

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: 04/22/2022

NARRATIVE

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Regarding the allegations that the "Facility is unkempt" and "Facility is malodorous". It was alleged that the facility is extremely filthy and has a strong odor. To investigate those allegations facility was toured including but not limited residents rooms, bathrooms, dining rooms and common areas, Interviewed Administrator, S1 - S6 and R2- R6. Staff interviewed denied the allegations. Staff stated that the facility is cleaned daily, and more frequently as needed. Administrator stated staff continuously clean the facility throughout the day. Housekeepers clean during their assigned shift and their duties include cleaning client rooms, emptying thrash from client rooms and bathrooms, cleaning and sanitizing restrooms and hallways. Residents interviewed were unable to corroborate the allegation. They stated that facility is clean. During the tour LPA observed the facility was well maintained (inside and outside) and there was no odor or malodorous smell coming from inside or outside of the facility. Based on LPA observations and interviews conducted with clients and staff there was not enough supportive evidence to concur with the reported allegations.

Regarding the allegation that "Facility has infestation of bugs". It was alleged that the facility has an infestation of bugs, and it gets worse during the summertime. To investigate those allegations facility was toured including but not limited residents rooms, bathrooms, dining rooms and common areas, Interviewed Administrator, staff and residents. Administrator And staff denied the allegation. They stated that the facility is not infested with bugs. They stated that the facility is frequently serviced by a pest control company. Review of pest control invoices did not indicate that the facility has a bug infestation. Residents interviewed were unable to corroborate the allegation.

Continue 9099C

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220412094959

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: 04/22/2022

NARRATIVE

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Regarding the allegation that "Facility failed to provide residents with clean linens" It was alleged that
the staff don’t provide the residents with clean linens. To investigate this allegation LPA interviewed administrator, staff, residents. Administrator and staff denied the allegation. They stated that residents are provided with clean linens frequently, 3 times per week, sometimes daily if needed. Staff checks on residents every 2 hours. When the incontinent residents are checked and staff observes the bed linens are soiled, staff will change bed linens within 10 -15 minutes. LPA observed the facility linen storage, had a sufficient amount of clean linens.

Although the allegations may have happened or are valid, there are 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 the Director Health Services

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

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