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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320053
Report Date: 03/13/2024
Date Signed: 03/13/2024 02:45:11 PM


Document Has Been Signed on 03/13/2024 02:45 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



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: 87DATE:
03/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Lourdes Menchaca-AdministratorTIME COMPLETED:
02:45 PM
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On 3/13/2024, Licensing Program Analysts (LPAs) Alfonso Iniguez and Darneisha Cross conducted an unannounced annual required visit using the CARE Inspection Tool. LPAs met with Lourdes Menchaca / Administrator. LPAs explained the purpose of today’s visit. The facility is licensed to serve (120) residents ages 60 and above. Of which (120) may be non-ambulatory. Approved hospice waiver for (30). Currently the facility has 87 residents.


The facility is a (4) four story structure located in a commercial building in a residential neighborhood. The facility consists of; (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, wellness room, nursing supplies, laundry chute 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.)

LPAs toured the physical plant with administrator. There were no bodies of water or obstructions on the premises. A total of (8) rooms were inspected: Rooms: 105, 113, 202, 208, 301, 308, 404, 411. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA reviewed last date fire inspection company came to check smoke detectors. The water temperature properly measured between 105F. and 120 F.

Evaluation Report Continues LIC 809-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SILVERADO SENIOR LIVING-BEACH CITIES
FACILITY NUMBER: 198320053
VISIT DATE: 03/13/2024
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LPAs Iniguez and Cross observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed, cleaning agents and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged and were operable. A review of (7) residents' service files, (7) staff personnel files were checked. (7) Medication Administration Records (MAR) were reviewed no discrepancies were found. First AID kit was checked. Last fire disaster drill was on:2/27/2024.

LPA observed the facility's infection control practices. Liability insurance will be emailed to LPA. Facility Annual Fess not Current, LPA gave PIN:221826 to Administrator during the visit. Administrator stated that company will send an overnight check to CDSS.

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


An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Lourdes Menchaca /Administrator.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
LIC809 (FAS) - (06/04)
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