565850072-2-23-2024-29-AS-KLOZ-D3SQMV-20240328121811

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850072
Report Date: 02/22/2024
Date Signed: 02/23/2024 10:50:17 AM

Substantiated

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: 49	DATE:	02/22/2024
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Heather Hampel		TIME COMPLETED:	03:32 PM

ALLEGATION(S):

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Staff are prohibiting resident from receiving family's phone calls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to deliver the findings pertaining to the allegation listed above. The LPA met with the Director of Healh services, Heather Hampel and explained the reason for the visit.

On 02/12/2024, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial 10-day visit to investigate allegations listed above. The LPA met with the Administrator Sabrina Pegross and explained the reason for the visit. At 11:50 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.
Continues on LIC 9099C...

Substantiated

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: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

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: 02/22/2024

NARRATIVE

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Staff are prohibiting resident from receiving family phone calls.
On the allegation that the staff are prohibiting the residents from receiving phone calls, the Reporting Party’s (RP) concern is that the R1 is not being allowed to receive phone calls (on the facility’s phone) from family members. To investigate the allegation the LPA attempted to interview the family members to ascertain the information received by the RP. The LPA made three calls between 02/12/2024 and 02/16/2024 at approximately 1:21 p.m.,1:35 p.m. and 12:30 p.m., however the calls went to voicemail. LPA Urena left voicemail. On 02/22/2024, the LPA communicated with family members from approximately 10:38 a.m. to 11:10 a.m. The family members stated that on several occasions, family members attempted to communicate with R1 via the facility’s phone, however they were told by facility staff that R1 was not available, and that the staff would have R1 called them back right away. The family members added that they never received the call back as they had expected. The family members further stated that they were able to speak with the administrator on 02/05/2024, and that on this date the administrator stated that they were not aware of the calls, and that they would interview facility staff about the calls that were never transferred to R1. Finally, R1’s family members stated that after the phone call with the administrator 02/05/2024, they have been able to communicate with R1 when they call the facility.

The LPA interviewed the facility’s administrator about the facility’s policy on phone calls. The Administrator stated that the facility has two cell phones available for residents’ use. If a family member/calling party calls the facility to communicate with a resident, the facility will bring one of the cell phones to the resident. Or if a resident wishes to use the cell phone, the staff will bring a cell phone to the resident. Sometimes the resident may have to wait for the cell phone to be available, if one of the two cell phones are being used.

Based on the information obtained through the interviews, the facility staff did not transfer calls to residents as expected, which prevented the family members from communicating with the resident. Therefore, the allegation that staff are prohibiting resident from receiving family phone calls, is Substantiated at this time.
Pursuant to Title 22 Regulations, deficiencies were cited (refer to LIC 9099-D).

Citations were issued. Exit interview conducted, a copy of the report, and Appeal Rights was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/22/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/08/2024 Section Cited CCR 85072(a)(b)	1 2 3 4 5 6 7	85072Personal Rights (a)In addition to Section 80072, the following shall apply. (b)The licensee shall insure that each client is …personal rights. To have access to telephones in order to make and receive confidential calls, provided that such calls do not infringe upon the rights of other clients and do not restrict availability of the telephone during emergencies. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The licensee will submit plan how they will ensure residents receive calls from calling parties in a timely manner. Submit the plan of correction to the department via email by 03/08/2024.
	8 9 10 11 12 13 14	Based on the information obtained through interviews, the licensee did not comply in the section cited above, as facility staff did not provide family members with the opportunity to communicate with R1, which may pose a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

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