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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530067
Report Date: 04/11/2024
Date Signed: 04/11/2024 10:59:33 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/02/2024 and conducted by Evaluator Anna Fannell
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240402222036
FACILITY NAME:SILVERLAKE SENIOR HOMEFACILITY NUMBER:
335530067
ADMINISTRATOR:VANNOY, JAMES M.FACILITY TYPE:
740
ADDRESS:6900 WELLS SPRINGS STTELEPHONE:
(951) 847-8395
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY:6CENSUS: 6DATE:
04/11/2024
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Leslie VannoyTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent a resident from hitting another resident while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Anna Fannell conducted an unannounced visit to this facility for the purpose of initiating the investigation of and delivering findings for the above allegation. LPA met with licensee Leslie Vannoy who was advised of the purpose of visit. Licensee left the facility before the conclusion of today's visit. The investigation consisted of interviews with relevant parties, and review of pertinent records.

It is alleged that Staff did not prevent a Resident (R1) from hitting another Resident (R2) while in care. Interviews revealed that residents were roommates and that the incident occurred in their room. Interview with R2 revealed that the incident was unprovoked and that staff responded immediately when called by R2. Interviews with staff and records reviewed confirm that R1 has a history of increasing aggressive behaviors.

Based on the available information, the complaint allegations are UNSUBSTANTIATED meaning that, 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. An exit interview was where this report was discussed and a copy was given to administrator April Lopez.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna FannellTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
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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