565850072-9-10-2024-29-AS-KHEN-D9FUCR-20240925152823

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850072
Report Date: 09/10/2024
Date Signed: 09/10/2024 11:10:13 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, 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
08/21/2024 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240821111712

FACILITY NAME:	SILVERADO THOUSAND OAKS, LLC		FACILITY NUMBER:	565850072
ADMINISTRATOR:	ROBLOE BABASANTA		FACILITY TYPE:	740
ADDRESS:	980 WARWICK AVE		TELEPHONE:	(805) 307-7300
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	82	CENSUS: 51	DATE:	09/10/2024
		UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Heather Hampel		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff are sleeping while on working hours

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation with the purpose of delivering findings for the above noted allegation. LPA met with Director of Health Services Heather Hampel and explained the reason for the visit.

During the initial visit conducted on 08/23/2024, LPA interviewed Executive Director (ED) at 10:48AM and LPA conducted a health and safety check tour of the facility at 11:25AM. LPA interviewed staff at 01:20PM, 04:00PM, and 04:15PM and obtained copies of pertinent documents. Throughout the course of the investigation, LPA reviewed documents and interviewed staff telephonically. The following was then determined:

It was alleged that staff are sleeping during the overnight (NOC) shift, however, no specific information was provided related to staff members involved nor a time frame indicated. LPA interviewed staff and
Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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-20240821111712

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SILVERADO THOUSAND OAKS, LLC	FACILITY NUMBER: 565850072
	VISIT DATE: 09/10/2024

NARRATIVE

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management and attempted to interview residents. Management indicated that there had been reports around January or February that staff were sleeping during their shifts. Management proactively conducted night audits and observations of the NOC staff. As a result of the audits, 2 (two) staff were terminated from employment at that time. LPA confirmed that ED was first associated with the facility on 01/22/2024 and ED stated that this had occurred around the time of his employment with the facility. Staff interviews revealed that there have been no other staff observed sleeping while on shift, nor have any staff heard of this occurring in the last 6 (six) months. NOC care staff indicated they work together during the shift to ensure both staff are awake, alert, and caring for the residents properly. Additionally, a nurse works during the NOC shift, who walks the building and frequently checks in with the care staff to ensure there are no problems or concerns. All staff interviewed indicated it would be nearly impossible for staff to sleep on NOC shift with the way they are currently operating. At the time the complaint was received and for the previous 6 (six) months, there were no reports of staff sleeping on NOC shift. Residents observed appeared well cared for and content but were unable to be interviewed. Based on interview, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation “staff are sleeping while on working hours” is deemed UNSUBSTANTIATED at this time.

No deficiencies cited during this visit. Exit interview conducted with Director of Health Services. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC9099 (FAS) - (06/04)

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