198603267-10-27-2022-28-AS-RORN-CL7RNV-20221115121055

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603267
Report Date: 10/27/2022
Date Signed: 10/27/2022 12:42:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
10/19/2022 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221019142854

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: 55	DATE:	10/27/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Vida Gwinn - Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility was odoriferous.
Facility staff are not meeting resident's hygiene needs.
Facility staff did not ensure that resident was wearing clothing free of rips.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Vida Gwinn (Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of the resident and staff rosters, interviewed Administrator, Staff 1 - Staff 4 (S1 - S4), Resident 1 - Resident 7 (R1 - R7), and conducted a facility tour.

The investigation revealed the following: regarding the allegation "facility was odoriferous", it is alleged that in the main living area where all residents stay, there was a smell of poop in the air and a caregiver was seen just sitting in one of the chairs. Administrator and staff interviewed denied the allegation and stated that any odor identified is immediately addressed by the staff. Residents interviewed could not corroborate the allegation. During the tour of the facility, the LPA did not smell any odors and observed staff interacting with the residents in the main living area. (CONTINUED TO LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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-20221019142854

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SILVERADO SENIOR LIVING-SIERRA VISTA	FACILITY NUMBER: 198603267
	VISIT DATE: 10/27/2022

NARRATIVE

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Regarding the allegation "facility staff are not meeting resident's hygiene needs.", it is alleged that residents are left sitting on their poop. Administrator and staff interviewed denied the allegation and stated that staff check and change diapers every 2 hours or as needed. Residents interviewed could not corroborate the allegation.

Regarding the allegation "facility staff did not ensure that resident was wearing clothing free of rips", it is alleged that a resident was walking around with a ripped shirt. Administrator and staff interviewed denied the allegation and stated that if a resident is seen with ripped clothes they are taken back to their rooms and have them change into other clothes are not ripped. Residents interviewed could not corroborate the allegation. During the tour of the facility, the LPA did not observe any residents with ripped clothes.

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 held and a copy of the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC9099 (FAS) - (06/04)

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