306005652-4-21-2021-22-AS-SSAS-C3BQBC-20210524120120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005652
Report Date: 04/21/2021
Date Signed: 04/21/2021 03:40:21 PM

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
10/02/2020 and conducted by Evaluator Michael Barrett

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201002125206

FACILITY NAME:	SILVERADO BREA LLC		FACILITY NUMBER:	306005652
ADMINISTRATOR:	KAUTEN, MARIA		FACILITY TYPE:	740
ADDRESS:	149 W LAMBERT RD		TELEPHONE:	(714) 598-2052
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY:	70	CENSUS: 25	DATE:	04/21/2021
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Executive Director (ED) Maria Kauten		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility failed to provide residents records upon written request

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mike Barrett initiated a complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s visit was conducted virtually with Executive Director (ED), Maria Kauten.
On 10/2/2021, the Community Care Licensing Division, Orange County Regional Office, received a complaint regarding the above allegation. LPA conducted interviews with the Executive Director (ED), Maria Kauten and the Reporting Party (RP) as well as reviewed documentation regarding the request for copies of Resident #1 (R1)'s records. The investigation revealed that the facility had received the request for documents on 9/25/2021, but was missing the signed Guardian ad Litem making the request incomplete and not valid. The facility was communicating with the RP for the required completed request to which the RP supplied the necessary forms on 10/8/2021. The facility fulfilled the request for documents as requested following the receipt of the required request form. This agency has investigated this complaint alleging that the facility failed to provide residents records upon written request. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened, and/or is without a reasonable basis. A telephonic exit interview was conducted with ED Kauten, and a hard copy was provided via email for signature.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Michael Barrett	TELEPHONE: (714) 703-2847
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021

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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