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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005453
Report Date: 09/16/2024
Date Signed: 09/16/2024 02:03:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/06/2024 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240906145147
FACILITY NAME:SILVER LINING RESIDENTIAL CAREFACILITY NUMBER:
306005453
ADMINISTRATOR:FADDOUL, LACYFACILITY TYPE:
740
ADDRESS:1243 N. BROOKHURST STREETTELEPHONE:
(661) 810-7293
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:14CENSUS: 11DATE:
09/16/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lacy FaddoulTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Unlawful eviction
Medication not being administered as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA was greeted and granted entry by staff. Staff called the Administrator and informed her of the visit. LPA met with Administrator Lacy Faddoul. LPA interviewed staff and residents. LPA reviewed facility records. The investigation into the allegation, unlawful eviction, revealed the following. It was alleged the Resident 1 (R1), was unlawfully evicted and not allowed to return to the facility after their hospital stay. On Friday August 30 2024, staff attempted to give R1 a shower and R1 became agitated and hit and scratched 2 staff members. Staff reported R1 was aggressive and yelling so they called 911. The Administrator and family members of R1 were notified. R1 was taken to the hospital. R1 was ready for discharge on September 04, 2024. The Administrator reported that after R1 was assessed they wanted R1 to have a one on one caregiver because of their recent behavior. On September 6, 2024, the Administrator, R1's family members, hospital social worker and the hospital physician who treated R1 had a conference call to discuss admitting R1 back to the facility and R1's plan of care.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
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 6
Control Number 22-AS-20240906145147
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SILVER LINING RESIDENTIAL CARE
FACILITY NUMBER: 306005453
VISIT DATE: 09/16/2024
NARRATIVE
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The Administrator reported the facility wanted one on one care for the safety of R1 and the other residents and staff. The hospital social worker, physician and R1's family members did not think one on one care was required. At issue was the hospital's use of Haloperidol lactate injections of 2 mg as needed for delirium. The Administrator reported that she provided a new care plan for R1 to R1's family members but they did not agree to the new care plan. The Administrator reported that after the conference call she was provided with a new physician's report. A review of the physician's reported provided at move in and the one completed at the hospital showed two differences. The new physician's report (dated September 4, 2024) lists R1 as able to dress/groom self and the one provided at move in (dated March 31, 2023) lists R1 is not able to dress/groom self. The physician reported dated March 31 lists R1 as able to administer their own medication and the physician reported dated September 4 lists R1 as not being able to administer their own medication. Neither physician's report lists Haloperidol Lactate 2 mg as a regular medication. The Administrator reported that their concern was the use of Haloperidol Lactate and why was it not being continued if it was being used for the resident at the hospital. R1's family members reported that the physician reported it was no longer necessary and R1 did not require one on one care. On September 10, 2024 R1's family members went to the facility and gathered R1's belongings and informed the Administrator that they have relocated R1. The Administrator reported that they refunded R1's family members for September 2024. A review of records shows R1's family members signed for R1's belongings and for the refund check for $1398.00. R1 was agitated and in distress and needed medical assistance so they were taken to the hospital on August 30, 2024. R1 was treated and the hospital was ready to discharge R1. The facility wanted R1 assessed prior to discharge. The Administrator assessed R1 on September 5, 2024 and sent a revised care plan to R1's family members. A conference call was conducted on September 6, 2024 with all parties regarding R1 returning to the facility and their plan of care. No eviction notice was provided to R1's family members. No action was taken until September 10, 2024 when R1's family members removed R1's belongings from the facility and reported to the Administrator R1 has been relocated. The facility reported they would take R1 back if the the physician's report stated that R1 did not required a one on care. The physician's report dated September 4, 2024 states R1 does not require one on one care. The facility did provide a new care plan but there is no medical documentation to show one on one care was needed. Based on the evidence gathered the preponderance of evidence standard has been met therefore the allegation is substantiated.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 22-AS-20240906145147
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SILVER LINING RESIDENTIAL CARE
FACILITY NUMBER: 306005453
VISIT DATE: 09/16/2024
NARRATIVE
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The investigation into the allegation, medication not being administered as prescribed, revealed the following. It was alleged that R1's was not given the proper amount of medication and that R1 was given medication after is was discontinued. A review of R1's medication administration record (MAR) for August 2024 shows that R1 did not receive 8 different medications on 10 different days. The Administrator reported that the blank spaces on the MAR are when R1 refused to take medication. There is no key on the MAR to indicate what is noted for a medication refusal. There is no indication on the MAR that R1 refused any medications. Based on the evidence gathered the preponderance of evidence standard has been met therefore the allegation is substantiated.

An exit interview was conducted and a copy of the report provided along with appeal rights.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 22-AS-20240906145147
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SILVER LINING RESIDENTIAL CARE
FACILITY NUMBER: 306005453
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/17/2024
Section Cited
CCR
87224(c)
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87224 Eviction Procedures
(c) The licensee shall, in addition to either serving the required thirty (30) days notice, sixty (60) days notice or... three (3) days notice on the resident, notify or mail a copy of the notice to quit to the resident's responsible person.
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The licensee agrees to read and review regulation section 87224 on Eviction Procedures. The licensee will send a signed statement of acknowledgement and understanding to LPA by the close of business on the POC due date.
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This requirement was not met as evidenced by: Based on interview confirmation and record review the licensee did not ensure the eviction process was followed according to regulation guidelines which poses an immediate personal rights risk to persons in care.
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Type A
09/17/2024
Section Cited
CCR
87468.1(a)(16)
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Personal rights of residents in all facilities. To receive or reject medical care or other services. This requirement was not met as evidenced by.
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The licensee agrees to read and review regulation section 87468.1 on personal rights of residents in all facilities. The licensee will send a signed statement of acknowledgement and understanding to LPA by the close of business on the POC due date.
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A review of records shows R1 did not receive all medication as prescribed which poses an immediate health and safety risk.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/06/2024 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240906145147

FACILITY NAME:SILVER LINING RESIDENTIAL CAREFACILITY NUMBER:
306005453
ADMINISTRATOR:FADDOUL, LACYFACILITY TYPE:
740
ADDRESS:1243 N. BROOKHURST STREETTELEPHONE:
(661) 810-7293
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:14CENSUS: 11DATE:
09/16/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lacy FaddoulTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not treat resident with dignity and respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Administrator Lacy Faddoul and explained the reason for the visit. The investigation into the allegation revealed the following. It was alleged that Resident 1 (R1) was forced to take a shower. 3 out of 3 staff interviewed reported R1 was soiled and needed to be showered. R1 has moved out of the facility and could not be interviewed. The Administrator reported that staff have not forced anyone to shower. All staff interviewed reported that R1 was soiled and for their safety and of others she needed to be cleaned. Staff reported they waited for R1 to become less agitated before they attempted the shower. Staff reported that R1 agreed to be showered and during the shower R1 became very aggressive and staff called 911. Staff attempted to redirect R1. 2 out of 3 staff present were injured by R1. 3 out of 3 staff reported that they did not hurt or restrain R1 in anyway. R1 was transported to the hospital to be evaluated. There is no evidence to prove the alleged violation did or did not occur.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20240906145147
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SILVER LINING RESIDENTIAL CARE
FACILITY NUMBER: 306005453
VISIT DATE: 09/16/2024
NARRATIVE
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Based on the evidence gathered the allegations is deemed unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6