198603267-10-27-2022-28-AS-MVAO-CMKTJS-20221229134649

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603267
Report Date: 10/27/2022
Date Signed: 10/27/2022 01:17:40 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
02/01/2022 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220201132645

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:	10/27/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Selene Rangel		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff have stolen resident's personal belongings.
Staff stole the resident's dog.
Staff do not treat the resident with dignity.
Staff have hit the resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted a “Subsequent” visit to ascertain additional information regarding the above-mentioned allegation(s) and for the purpose of rendering the findings.
LPA met with RN Selene Rangel and explained the reason of the visit and also assisted LPA with the visit.

The investigation consisted of the following: On 2/2/2022, LPA Sicairos conducted the initial 10 days complaint visit and obtained copies of Staff and Resident Rosters. LPA requested copies from Resident #1 (R1's) file. On today's date, LPA also interviewed the administrator, four staff (S1-S4) and five residents (R2-R6).

(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
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-20220201132645

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: 10/27/2022

NARRATIVE

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The investigation revealed of the following: In regards to the allegation "Staff have stolen resident's personal belongings" LPA interviewed residents and all denied the allegation and reported no staff ever stole their personal belongings and they never missed or lost anything in the facility. LPA interviewed staff and reported when R1 first moved into the facility. R1 only came in with few clothes and a fanny pack. The facility and conservator had to buy her extra items that R1 needed. R1 also has a court appointed conservator for her finances and medical decision.

In regards to the allegation "Staff stole the resident's dog." LPA interviewed administrator and staff and all reported R1 did not have a dog when R1 moved into the facility. The dog chewy is the facility dog and he's a therapy dog for the residents in the facility. All residents can play with the facility dog. Staff also stated that R1 would even claim chewy as her own dog.

In regards to the allegation "Staff do not treat the resident with dignity." LPA interviewed residents and all denied the allegation and reported all staff are nice to them and respect them and they are happy living in the facility. LPA interviewed staff and all denied the allegation and reported no staff ever witness any staff being disrespectful to residents in the facility. Staff also reported only R1 was being disrespectful to the staff. R1 would yell and scream and curse at staff and other residents in the facility.

In regards to the allegation "Staff have hit the resident." LPA interviewed residents and all denied the allegation and reported they never witnessed any staff hit residents and reported all staff are nice and its never happened in the facility. LPA interviewed staff and all denied the allegation. It had never happened in the facility. The facility would not allow staff doing it and they are all mandated reporter. Staff also stated that no staff even want to get near to R1 due to her behaviors.

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 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. A copy of the report and appeal right was provided to the RN Selene Rangel

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
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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