197609117-3-8-2022-29-AS-ASMH-CCBVM8-20220308153307

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609117
Report Date: 03/08/2022
Date Signed: 03/08/2022 03:33:44 PM

Document Has Been Signed on 03/08/2022 03:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	SILVERADO SENIOR LIVING - CALABASAS		FACILITY NUMBER:	197609117
ADMINISTRATOR:	VIDA GWINN		FACILITY TYPE:	740
ADDRESS:	25100 CALABASAS RD		TELEPHONE:	(818) 222-1000
CITY:	CALABASAS	STATE: CA	ZIP CODE:	91302
CAPACITY:	110	CENSUS: 55	DATE:	03/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kim Davis, Health Services Director		TIME COMPLETED:	03:30 PM

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Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 1:00 p.m. This annual had a specific emphasis on infection control practices and procedures. In attendance included Public Health Nurses Lynn Tobola and Myra Valencia, and virtually, parties were joined by Dr. Al-Ahmad with the Los Angeles County Department of Public Health, and Licensing Program Manager Jeralyn Pfannenstiel. All parties met with Health Services Director Kim Davis and Esther Chico-Gutierrez and explained the reason for the visit.

The physical plant area was toured to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. At the time of the visit, the facility has active COVID-19 cases. Hence, the purpose of today’s visit was to provide technical assistance as it related to the current outbreak.

FRONT DESK: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. Staff were instructed to update the exposure notification form to reflect the current outbreak; said postings were found on the front entrance to the facility and in the staff break room. In addition, staff were instructed to post the notification form in a visible location.

KITCHEN: Kitchen appliances were in operable condition. At this time, residents whom are designated in the yellow and red zones have separate dining halls. Staff are limiting the number of residents at a table, and some residents are being served in their room.

RESTROOM: Restrooms were stocked with soap and paper towels. Hand-washing signs promoting good hand hygiene were observed. Staff were instructed to label restrooms designated for staff, and to ensure that hand-washing signs were posted consistently in both English and Spanish formats.

CLEANING: Staff stated that all high-touch surfaces were being cleaned every two hours. In addition, all tables and areas are wiped down after every meal. Staff were reminded to be mindful of the appropriate contact time as it pertained to the cleaning solution. At this time, the facility’s cleaning protocol is adequate.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 SENIOR LIVING - CALABASAS	FACILITY NUMBER: 197609117
	VISIT DATE: 03/08/2022

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VISITATION: In-person visitation is on hold at this time. However, the facility is allowing for alternative forms of communication (virtual, telephone calls), and essential visitation is allowed at all times.

LAUNDRY: If possible, there should be separate staff assigned to wash the clothing of residents in the yellow versus the clothing of residents in the red zone. Best practices were shared regarding how staff are minimizing exposure risk; hence, staff will take a different route of entering the laundry room during the duration of the outbreak.

COMMON SPACES: Walls and flooring were checked for cleanliness and good condition. Required postings promoting physical distancing, mask wearing, and promoting good hand hygiene were posted. Staff were reminded to be mindful of the maximum number of persons that can be in an enclosed space. Staff were also instructed to post appropriate signs in the staff break area to promote regular disinfecting of commonly touched surfaces.

INFECTION CONTROL: All parties spoke Health Services Director regarding the facility’s infection control practices. Staff were reminded that during the duration of the outbreak, staff must properly wear an N95 mask at all times. All staff have been properly fit tested for an N95 mask. It was communicated that the facility has an adequate supply of Personal Protection Equipment (PPE) and can obtain additional supplies as needed. At this time, there is a separate red zone for residents with a confirmed diagnosis of COVID-19. Staff were observed wearing full PPE in the red zone. During today’s visit, there were no immediate health or safety hazards observed.

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: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

LIC809 (FAS) - (06/04)

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