565850072-9-7-2022-29-AS-JAPL-CJ9VUV-20220914164520

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850072
Report Date: 09/07/2022
Date Signed: 09/07/2022 12:26:59 PM

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
04/04/2022 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20220404125919

FACILITY NAME:	SILVERADO THOUSAND OAKS, LLC		FACILITY NUMBER:	565850072
ADMINISTRATOR:	WILKIN, RONDA		FACILITY TYPE:	740
ADDRESS:	980 WARWICK AVE		TELEPHONE:	(805) 307-7300
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	82	CENSUS: 55	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Hope Langston		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Facility failed to have planned activities

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent visit. The LPA met with Hope Langston and explained the reason for the visit.

During the initial visit conducted on 4/8/2022, the LPA interviewed staff from 10:10 a.m. - 2:15 p.m., conducted a file review, obtained documents, and observed Resident #1 (R1) participating in a facility activity. Today, the LPA obtained documents and interviewed staff at 10:05 a.m., 10:35 a.m., and 10:47 a.m., and 12:10 p.m.

Regarding the allegation, it was alleged that the facility did not have activities and that they did not follow the scheduled program of activities as planned. Staff interviews revealed that the facility had daily activities; however, the schedule would sometimes change depending on the interest of residents whom attended and/or vendor availability. However, the facility has a number of company- approved activities to choose from should a substitution be deemed necessary.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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-20220404125919

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: 09/07/2022

NARRATIVE

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Staff noted that all residents are encouraged to attend activities and staff will oftentimes go room to room to remind, escort, and encourage residents to participate in group activities.

Regarding R1, staff claimed that R1 would oftentimes stay in their room and preferred to participate in solo activities, such as reading the newspaper in their room. Staff also noted that throughout R1's stay in the facility, R1’s participation in group activities has declined due to lack of interest, yet will occasionally participate in activities centered around music. Staff claimed that they continue to encourage and ask R1 to attend group activities, but R1 will oftentimes opt out. During the initial visit on 4/8/2022, the LPA observed R1 participating in a group activity.

Based on the information obtained, there is insufficient evidence to support claims that the facility failed to have planned activities. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC9099 (FAS) - (06/04)

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