Silverado Safety & Abuse Initiatives

Silverado created a world class Safety and Abuse Prevention Initiative in response to a tragic event in the fall of 2007. Following are the key features of the Silverado Safety and Abuse Prevention Initiative:

Dec. 2007 - Associate Abuse Acknowledgement

All company associates (over 2,000) were required to re-attend the abuse prevention and reporting in-service (this in-service is normally conducted upon hire and annually.) In addition, each associate was required to re-sign the Associate Abuse Acknowledgement (normally signed upon hire) indicating their complete understanding of their responsibilities in the case of resident, patient or client abuse.

Nov. 2007 - Jan. 2008 - Policies and Procedures

The CEO and SVP of Operations conducted in-person or teleconference meetings with leadership teams from each community and service line to discuss our policies and procedures for abuse prevention, clearly articulate our position of zero tolerance for elder abuse, allow associates to ask questions, share information, etc.

In addition to these meetings with associates, the CEO and SVP of Operations held family meetings in each Silverado community to discuss the current situation regarding our Calabasas community as well as clearly outline our company stance on abuse, abuse prevention policies and procedures, company operating philosophies, etc.

Feb. 2008 - Annual Retreats Creating a Safe Environment

At the Silverado Annual Retreat including all executives, Administrators, and field management staff, a sizeable amount of the agenda was committed to discussing engaging our associates and creating a safe environment for communication. In particular, how to create an environment for associates to feel safe to report questionable behavior, offer suggestions and eliminate fear from other associates.

Members of the Executive committee (SVP Clinical Services and Regional Vice President of Operations) attended 2nd annual International Conference on Elder Abuse to continue to learn and become educated on opportunities for Silverado to enhance its existing abuse prevention strategies.

At the Director of Health Services annual retreat the SVP of Clinical Services and her Regional Directors spent a considerable amount of time discussing with Directors of Health Services abuse prevention. Many executive team members including the CEO and all Administrators from the communities attended one day (out of state Administrators were flown in) of this retreat to discuss abuse prevention.

Dec. 2008 - Teleconference

Teleconference calls were held with all leadership team members to discuss the current status of our Calabasas community as well as once again articulate the company's position on abuse prevention, zero tolerance for non-compliance, creating a safe environment for associate interaction and ability to approach management, etc.

May 2008 - Annual meeting for Silverado's Medical Directors

Included agenda items focusing on abuse prevention.

Cultural Diversity Curriculum at the ALFA Conference in Florida discussions began with University of Maryland, Baltimore Campus (UMBC) Erickson School of Aging to develop a curriculum for Silverado specific to the cultural differences among our associates and their cultural views of caring for the elderly, abuse, etc. As well as to better understand each other in growing and developing a team, improving communication, etc.

June 2008 - Abuse Prevention

Silverado conducted two additional abuse prevention symposiums (TX and CA) participates included Executive Team, Sr. Director of Human Resources, Director of Employee Relations, Director of Risk Management, Administrators from all service lines from California, Utah and Arizona; Directors of Health Services from California, Utah and Arizona; Directors of Patient Care Services from California and Utah; Geriatric Care Managers from California; Director of Quality Assurance, Director of Clinical Education, Administrators from all service lines from Houston and Dallas; Directors of Health Services from Houston and Dallas; Directors of Patient Care Services from Houston and Dallas; Geriatric Care Managers from Houston and Dallas

July 2008 - Associate Concern Hotline

An Associate Concern Hotline (800#) has been established to provide all associates a safe and confidential way to alert management of any inappropriate behaviors, concerns or any other information they would like to share. To date, no reports of abuse have been made to the hotline.

Associate support groups are being established facilitated by and outside professional allowing opportunity for associates to convene and share issues, work through grief, have safe environment for communication and sharing. These continue in all communities to date.

A follow up meeting was held with the UMBC Erikson School of Aging Dean Kevin Eckert, David Sach, Vice Dean, Dr. William Fulmer, Professor of Practice, Deborah Adler, Director of Education and Silverado Senior Living CEO, Chief Administrative Officer and Senior Director of Organizational Development to discuss the development of a curriculum and follow up training specific to the cultural differences among our associates and their cultural views of caring for the elderly, abuse, etc. As well as to better understand each other in growing and developing a team, improving communication, etc.

All associates are given a pre-screening assessment tool designed to indentify individuals whose personalities may be incompatible with Silverado core values, service principles and job position demands.

Aug. 2008 - Town Hall Meetings

The CEO and SVP of Operations are conducting face to face "Town Hall Meetings" with all line staff without any local managers present. This is intended to allow associates to feel safe to share any concerns, need and to voice their opinions, etc.

In addition the CEO and SVP of Operations are meeting with leadership teams in each community during these visits.

March 2009 - Silverado Senior Living-Calabasas

Systems are being installed to ensure better between schedule communication from caregiver to caregiver. In addition we will complete specialized resident observations by nurses daily and by caregivers and nurses during shower/bath times to ensure recognition of injuries, skin problems or bruising of any kind.

Quarterly inspections at Calabasas for three years by the Department of Social Services.

With the help of an outside consultant, Silverado Senior Living-Calabasas will conduct annual reviews of its resident care to ensure the appropriate care of its residents, with particular attention paid to staffing levels, training needs and training curriculum, administrator performance, reporting requirements and other services.

Silverado provides to all direct care staff a minimum of six hours of quarterly training on mental health assessments, client behaviors, medication, suspected elder abuse detection and reporting requirements, maintaining daily charting of observations of and comments on each resident about changes in their physical, mental, emotional, and social functioning and their needs, preparing and providing timely special incident reports, proper client hygiene, health conditions, care of individuals with dementia, and preparation of care plans.

Silverado Senior Living-Calabasas has increased its direct care staff to resident ratios during its morning and afternoon shifts (by one caregiver per shift)

May 2009 - Elder Abuse Prevention

Silverado Senior Living has presented on the topic of Elder Abuse Prevention and has opened the dialogue between providers to discuss on a national level threw the Assisted Living Federation of America.

June 2009

Silverado Senior Living has presented on the topic of Elder Abuse at the California Assisted Living Association.

Additional Information:

Silverado has initiated small group/departmental meetings including leadership teams and Administrators to review elder abuse prevention and reporting throughout the company.

Held companywide meetings conducted by CEO and SVPs on how to review our current abuse prevention policies and practices and how to improve them.

Company executives drafted and implemented a revised, comprehensive abuse investigation and documentation policy and procedure.

Silverado provided on-site leadership (i.e. Administrators, DHS's) greater flexibility to terminate anyone they are suspicious of inappropriate behavior in their position.

Established the company's strategic initiative of having only engaged associates and acting accordingly on those who are not.

"Normalization training" frequency conducted by the Chief of Culture has increased. Numerous additional and ongoing training taking place.

PASS review surveys implemented in all communities.

It has been calculated that to date, the Executive team and others has spent over 11,500 hours in addressing the issues related to Calabasas and the needs associated with creating a world class abuse prevention initiative for our company.

Over $500,000 (excluding legal costs) has been spent in this area so far.

In summary, Silverado has and will continue to commit all the time, money and resources necessary to ensure each and every resident, patient and client is safe and cared for as we'd want and expect for our own family members. This safety and concern also applies to the families of those we serve as well as our associates.

Silverado Senior Living will continue to be relentless in its pursuit of excellence and world class care and services.