198320053-3-20-2022-11-AS-ASOO-CCMT6N-20220318142724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320053
Report Date: 03/18/2022
Date Signed: 03/20/2022 12:01:20 PM

Document Has Been Signed on 03/20/2022 12:01 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SILVERADO SENIOR LIVING-BEACH CITIES		FACILITY NUMBER:	198320053
ADMINISTRATOR:	GASPERIAN, DAIZEL		FACILITY TYPE:	740
ADDRESS:	514 N. PROSPECT AVE		TELEPHONE:	(949) 240-7200
CITY:	REDONDO BEACH	STATE: CA	ZIP CODE:	90277
CAPACITY:	120	CENSUS: 60	DATE:	03/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Lourdes Menchaca, Administrator		TIME COMPLETED:	02:00 PM

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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required visit and an infection control inspection to the above facility. LPA was met by receptionist (Julia Vega) and later met with Lourdes Menchaca, Administrator and the purpose of today’s visit was explained.

There are currently (60) residents in the facility. (0) residents are ambulatory and (60) are non-ambulatory. The facility is a (4) four story structure located on a commercial building in a residential neighborhood. The facility is in east side of the commercial building. It consists (110) bedrooms, (71) bathrooms, 1st floor, 2nd floor, 3rd floor, and 4th floor are mirror image of themselves. all the floors contain lounge / movie room, kitchenette, clean linen rooms, mechanical rooms, activities/dining room. activities storage room, Well-ness room, nursing supplies, laundry shoot room. 1st floor has a fireplace in lounge room, shaded side yard with gazebo, plants, and play area, 2nd floor has an incontinence room/staff lounge, and 4th floor has PT/gym room. The basement has (kitchen, laundry room, and PPE storage.)

LPA and Administrator toured the entire facility inside and out. Documents are posted as mandated. Most bedrooms are occupied by residents and contain the mandated furniture. All bathrooms are clean and operational. First aid kit completes with manual; smoke detectors and carbon monoxide detector are connect with fire department, system was in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. 3 staff files are complete and current. 3 residents files with medication are complete and current. Ample supply of perishable and nonperishable food, hot water temperature is 113.2 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 17 fire extinguishers are fully charged. Exit, walkways and/or passageways, side yard are free of debris and/or hazards. The facility is in good repair.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SILVERADO SENIOR LIVING-BEACH CITIES	FACILITY NUMBER: 198320053
	VISIT DATE: 03/18/2022

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During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged, and temperature checked, sanitizer/soap in all bathroom with paper towels and additional sanitation supplies are locked in storage rooms on each floor. LPA observed staff and clients wearing masks, residents’ private rooms will be converted to isolation rooms (if needed) and required postings throughout the facility. The facility has an approved Mitigation plan. The resident’s temperatures are checked and logged once a day. PPE's are enough for 30 days.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview conducted with Lourdes Menchaca, Administrator and a hard copy of report provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

LIC809 (FAS) - (06/04)

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