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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320053
Report Date: 03/04/2021
Date Signed: 09/02/2021 09:55:33 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CITIESFACILITY NUMBER:
198320053
ADMINISTRATOR:GASPERIAN, DAIZELFACILITY TYPE:
740
ADDRESS:514 N. PROSPECT AVETELEPHONE:
(949) 240-7200
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90277
CAPACITY:120CENSUS: DATE:
03/04/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Daizel Gasperian, AdministratorTIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPA) Ana Soto, conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation. Due to the situation surrounding the Corona virus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted a tele-visit with Daizel Gasperian, the facility administrator.

An application was submitted to Community Care Licensing Department (CCLD) on 08/19/2019 for an initial license for Residential Care For Elderly 60 years and above. The requested capacity is for (120) Residents,(0) ambulatory and (120) non-ambulatory. Structure: Facility is in a office building with other business offices. The facility has 4 floors, 60 rooms, and 1 elevator. The suite is on the First floor it has a lobby, receptionist counter, administrators office, sales office, and file room on one side of the first floor. They have the required Covid-19 posting on the front door of the Suite, along with the sign-in log sheet and sanitary station. Across the hall from the suite, they have the residents rooms. The resident section is on the 1st Floor. They have a common area (TV, Piano, 4 chairs, computer area) dining room, patio has( 2 tables, 2 umbrellas, and 2/3 chairs, and game tables.) Next to the dining area there's a kitchenette for staff. The wellness room is located right in middle of the floor, for all 4 floors. The 2nd, 3rd, and 4th floors are the same the design as the first floor. Signal System: Signal system in facility. Bedroom Residents: There shall be no more than two clients per bedrooms. bedrooms are designated resident bedrooms properly equipped with regulation guidelines of two beds, two chairs, two night stands, two lamps and overhead lighting. Presently, 120 bedrooms are occupied by 2 clients and 1 bedroom by 1 client. Bedroom Staff: No bedrooms will be used for awake staff. Bathrooms: 64 bathroom, 60 located in each room of the 4 floors of the facility: have working toilets and wash basin, a walk-in shower with folding bench, grab bars, and mats. 4 other bathrooms are visitor bathrooms, located 1 in every floor. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen is stored in basement where the house keeping supplies are kept.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021
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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SILVERADO SENIOR LIVING-BEACH CITIES
FACILITY NUMBER: 198320053
VISIT DATE: 03/04/2021
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Emergency Phone Numbers, Exit Plan, & Menu: Emergency numbers and menu are posted and readily available for review in suite lobby. Facility has a land line telephone located in the suite lobby. 1 Fire extinguisher, in the kitchen area which is labeled, they are tagged with current annual checks.

Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in locked storage drawers in the kitchen cabinets. Adequate food supply is stored in kitchen, and consists of the following: 2 day perishables, and 7 week non-perishables. Smoke Detectors: There are 60 hard wired smoke detectors, sprinkler system in all the facility which are inter connected. Carbon monoxide detector near the sprinkler system by room 101. Appliances: Stove burners, oven, microwave, freezers and washers/dryers are in working condition. The residence is equipped with central heat and air conditioning. There are 10 thermostat's for each floor to regulate the temperature in the residents rooms. Toxins: Cleaning supplies, and toxins are stored in the laundry room in the basement. Water Temperature: Water was tested in bathrooms and kitchen sink within 105-120 degrees Fahrenheit range. Medication, First-Aid Kit & Book: Designated area for centrally stored medication is located the 1st floor wellness room. A first-aid kit has been inspected which has at least the following: thermometer, tweezers ,scissors, antiseptic, bandages, gauze and current first aid manual, which are stored with medication in the wellness room, available for staff use but inaccessible to clients. Clients & Staff Files: Designated area for files will be located in the 1st floor suite next to administrators office. Pools/Jacuzzi & Pets: No bodies of water and no pets on these premises. . Fire Clearance: Fire clearance does not indicate any delayed egress or any locked perimeter. Component III and LPA also explained ROM 20-28 at the time of the Pre-Licensing.



There are no corrections to be made.

A tele-visit exit interview was conducted and a copy of this report has been furnished to the applicant via email for signature. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021
LIC809 (FAS) - (06/04)
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