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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608179
Report Date: 02/18/2022
Date Signed: 06/27/2022 09:18:00 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2022 and conducted by Evaluator Ana Soto
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220211121548
FACILITY NAME:SILVERADO SENIOR LIVING - BEACH CITIESFACILITY NUMBER:
197608179
ADMINISTRATOR:DAIZEL GASPERIANFACILITY TYPE:
740
ADDRESS:514 N PROSPECT AVETELEPHONE:
(310) 896-3100
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90277
CAPACITY:0CENSUS: 61DATE:
02/18/2022
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Jessica Ponce, Director of Health ServicesTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not follow COVID-19 protocol for quarantining residents from the public
Staff did not seek medication attention for resident timely
Staff improperly used oxygen machine on a resident without prescription
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Ana Soto and Jeremiah Randle conducted a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Jessica Ponce, the facility Director of Health Services and the purpose of the visit was explained.

The investigation consisted of following: Interviews with S#1 - S#5 and Record reviews. LPA Soto received the following documents on 02/18/22: Resident Roster, Staff Schedule, Face sheet, Physician's Report, Hospice file, facility medical notes 02/2021, Service file plan, and Potriast notes.

Based on the LPA's investigation, the investigation revealed the following. For Allegation 1 – Staff did not follow COVID-19 protocol for quarantining residents from the public. LPA interviewed S#1 - S#5, they all stated that the facility followed all Covid - 19 protocols. LPA had no concern and/or aware by facility of any problems adhering to infectious control practices.







Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20220211121548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SILVERADO SENIOR LIVING - BEACH CITIES
FACILITY NUMBER: 197608179
VISIT DATE: 02/18/2022
NARRATIVE
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The facility followed PIN 20-07-CCLD - Covid-19 pandemic protocols. The facility added precaution screening for COVID was implemented on 03/13/20. The facility was following DPH protocols and regulations. The staff had colored signs posted to identify the different zones for Covid Positive and /or negative facility floors. The 1st Floor was green for (not positive), 2nd floor was yellow (symptoms) quarantine.) 3rd floor was red (positive.) They were testing residents every week, sooner if residents showed any symptoms. The had plenty of PPE’s 2-week supply, to have staff change every time they entered and exited the different colored zones. The interviews conducted did not concur with the above allegation. On 02-18-22, when the LPA conducted the investigation, the facility followed the following PINs: PIN 21-43-ASC, Mitigation Plan. The were following their mitigation plan and had it posted in the facility. PIN 21-38-ASC-Fit testing, all the staff was fit tested for N95 masks. PIN 21-53 – ASC, Required vaccinations and boosters. All the staff was vaccinated and had booster shots too.

Allegation 2 -Staff did not seek medication attention for resident timely. Interviews with S#1 -S#5 they all stated that they did not recall or know, if R#1 was ever sent to the hospital. Record review revealed that R#1 was put into hospice, because of her deteriorating medical condition. R#1 was being taken care of at the facility by hospice. Hospice was providing all of R#1's medical needs. The interviews and records reviewed did not concur with the above allegation.

Allegation 3 - Staff improperly used oxygen machine on a resident without prescription. Interviews with S#1, S#2, S#3, and S#4, they all stated that the staff always follow procedures regarding the oxygen machine. The facility always has extra oxygen machine, they will never use the same oxygen machine for different residents. Every resident has their own at all times. Hospice residents are all given their own oxygen machine. S#5 they stated that they did not work on the 4th floor with R#!, S#5 could not provide any information. Records reviewed revealed that R#1 had her own oxygen machine and it was serviced 02/03/2021. Interviews and records reviewed did not concur with the above allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated

A exit interview was conducted with Jessica Ponce, Director of Health Services, and a hard copy was provided.




SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2