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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005453
Report Date: 03/01/2024
Date Signed: 03/01/2024 10:36:09 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/23/2024 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20240223151431
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: 12DATE:
03/01/2024
UNANNOUNCEDTIME BEGAN:
08:27 AM
MET WITH:Miriam EsquivelTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff would not allow residents provider to visit the resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. LPA spoke with Administrator/ Licensee Foudil via telephone.
During the course of the investigation, LPA interviewed staff, resident, and witness as well as reviewed and obtained pertinent documentation such as sign in logs and physician report. Regarding the allegation that staff would not allow residents provider to visit the resident, the investigation revealed the following: On 02/23/2024 at 12:30 PM, provider stated they arrived for a visit with Resident 1(R1) and was told by staff that the resident was not present at the facility. Provider states being denied entrance. Subsequent information revealed the resident was at the facility during that time frame. Three out of three facility staff deny the incident and state visitors are never denied visitation. The resident's durable power of attorney (DPOA) indicates provider does not come to facility as scheduled nor provide the services they are contracted to do. LPA observed ring footage that did not show the provider at the front door. CONTINUED ON LIC 9099C DATED 03/01/2024
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
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 2
Control Number 22-AS-20240223151431
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SILVER LINING RESIDENTIAL CARE
FACILITY NUMBER: 306005453
VISIT DATE: 03/01/2024
NARRATIVE
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Based on interviews conducted and video footage, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are 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.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2