565850072-2-12-2024-29-AS-KLOZ-D3SQMW-20240328121812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850072
Report Date: 02/12/2024
Date Signed: 02/12/2024 07:32:36 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/06/2024 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20240206125039

FACILITY NAME:	SILVERADO THOUSAND OAKS, LLC		FACILITY NUMBER:	565850072
ADMINISTRATOR:	SABRINA PEGROSS		FACILITY TYPE:	740
ADDRESS:	980 WARWICK AVE		TELEPHONE:	(805) 307-7300
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	82	CENSUS: 48	DATE:	02/12/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Sabrina Pegross		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff do not provide daily activities for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial 10-day visit to investigate allegation listed above. The LPA met with the Administrator Sabrina Pegross and explained the reason for the visit.

At 11:30 a.m. the LPA requested records pertaining to the complaint, and interviewed the Administrator from 12:00 p.m. to 12:30 p.m. The LPA interviewed the resident #1(R1) from 12:45 to 1:10 p.m. At the time of the R1’s interview, R1 appeared to be alert and oriented to questions during the interview.

Staff do not provide daily activities for residents.
On the allegation that staff are not providing daily activities for residents, the LPA interviewed the Administrator about the activities offered to residents. The Administrator provided a monthly calendar for activities available to residents. Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

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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Control Number 29-AS-20240206125039

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SILVERADO THOUSAND OAKS, LLC	FACILITY NUMBER: 565850072
	VISIT DATE: 02/12/2024

NARRATIVE

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The LPA reviewed three Activity Calendars for the month of February. The facility offers three types of activities throughout the day: Sensory, Social, and Enrichment. The activities are designed to provide different types of engagement for residents (depending on the ability). The LPA observed a group of residents attending an activity at around 11:00 a.m. The activity was called “Brain Games”. Additionally, the Administrator provided pictures of R1 participating in at least two different activities in two separate dates. The R1’s interview revealed that the staff are very nice and do assist the R1 to walk.

Based on the information obtained through interviews and record review, the allegation that the staff do not provide daily activities, is deemed Unsubstantiated at this time.

Exit interview was conducted, and a copy of the report was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

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