198320053-6-3-2023-11-AS-JHAD-CU9RWW-20230731132342

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320053
Report Date: 05/30/2023
Date Signed: 06/03/2023 12:04:18 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
12/13/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221213101417

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: 88	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	12:56 PM
MET WITH:	Lourdes Menchaca, Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility fire alarm system not working properly.
Facility is in disrepair.
Facility staff failed to administer medications as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Lourdes Menchaca, Administrator

The investigation consisted of following: Interviews and Record reviews. On 12/19/22, LPA Montoya interviewed S#1 – Lourdes Montoya – Executive Director and toured the facility with Administrator Lourdes Menchaca. LPA requested a resident roster, staff roster and copies of one resident's (R1) service records: Admission Agreement, Physician’s Report and Appraisal, Medication Administration Records, Nurses Notes, and other pertinent records. On 05/16/23, LPA Soto conducted interviews with S#1 - Executive Director, S#2 - S#9, and R#1 - R#8. The LPA Soto also requested copies of the following documents: Partial file for R#1 (Physician's report, Physician notes, and progress notes.) Resident roster, Staff roster, MARs for (November and December 2022,) and Staff shift schedule for December 2022.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221213101417

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: 198320053
	VISIT DATE: 05/30/2023

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following.

Allegation 1 - Facility fire alarm system not working properly. Interviews conducted with S#1, S#2, S#4, S#3, communicated that the fire alarm had been going off, but the building (beach cities) had the problem with the fire alarm. Silverado side had no issues with the fire alarm. The Silverado side could hear the alarm, but the beach cities side of the building had the issue, and they were working on resolving the fire alarm problem. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation.

Allegation 2 - Facility is in disrepair. Interviews conducted with staff #1 – S#9, communicated that the facility did not have problems with the lights in the common areas. S#1, S#2, and S#4 do not recall if R#1 rooms needed light bulbs or not, they can’t remember. S#1 – S#9, also communicated that if anytime any light bulbs are needed, maintenance will replace them right away as soon as it’s reported. The facility is in great condition, maintenance is real good at fixing anything that needs repair. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation.

Allegation 3 - Facility staff failed to administer medications as prescribed. Interview conducted with S#9, communicated that they spoke with R#1 family member and informed them that they had not administered R#1 medication personally, someone had given R#1 medication, but they were not sure who had administered R#1 medication, they had to look at R#1 chart to see who administered medication. RP, misunderstood S#9, that they had failed to administered medication to R#1. LPA reviewed Mars for November and December 2022; medication was administered as prescribed by physician. Interviews conducted with staff #1 - S#8, communicated that they have never heard of any residents missing or not been given their medications. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews and records reviewed did not concur with the above allegation.

Although the allegation 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

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

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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