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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320053
Report Date: 04/07/2026
Date Signed: 04/07/2026 04:10:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/09/2025 and conducted by Evaluator Regina Cloyd
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250709112537
FACILITY NAME:SILVERADO SENIOR LIVING-BEACH CITIESFACILITY NUMBER:
198320053
ADMINISTRATOR:LOURDES YVETTE MENCHACAFACILITY TYPE:
740
ADDRESS:514 N. PROSPECT AVETELEPHONE:
(949) 240-7200
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90277
CAPACITY:120CENSUS: 96DATE:
04/07/2026
UNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Lourdes MenchacaTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Due to staff neglect, resident sustained injuries.
INVESTIGATION FINDINGS:
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On 04/07/2026, Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent visit to gather information regarding the above allegation. LPA met with Administrator Lourdes Menchaca and the purpose of the visit was explained.

Investigation consisted of the following: On 07/16/2025, LPA obtained Resident Roster (as of 07/01/2025), staff schedule, June 2025 and July 2025 Medication Administration Record (MAR), Physicians Report, Plan of Care, Vitals, and Progress Notes for Residents #1-10. LPA interviewed nine staff members (S1 – S9) and four witness interviews (W1 – W4) and toured the first and fourth floor. On 10/13/25, LPA received a Personnel Record (10/13/25). On 10/17/25, LPA received R1’s Providence Little Company of Mary Torrance Medical Record. On 11/03/25, LPA left a voicemail for Staff #10. On 11/12/25 and 11/16/25, LPA left a voicemail for Staff #11. On 11/29/25, LPA received R1’s death certificate. On 01/12/26, LPA interviewed Staff #10 (S10) and Staff #11 (S11). On 01/27/26, LPA interviewed Staff #12 (S12). On 03/23/26, LPA received the second-floor facility sketch. Continue to LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 11-AS-20250709112537
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 04/07/2026
NARRATIVE
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Investigation revealed the following:
Regarding the allegation, “Due to staff neglect, resident sustained injuries,” it is alleged Resident #1’s (R1) fall resulted in lacerations all over R1’s body. Record review of R1’s Hospital Physical Therapy OPIB Plan of Care revealed R1 fell (04/08/25) prior to admission and sustained a fracture on part of the hip joint. R1 was non-weightbearing for six weeks. Record review of R1’s Physician’s Report (04/21/25) revealed R1 is non weight bearing on right lower extremity and needs assistance with toileting needs. Review of Service Plan (06/01/25) revealed R1 was dependent on staff members for all mobility/ambulation needs, required hands on assistance by staff members, able to hold weight for few steps with one-person assist but then becomes weak. R1 was a fall risk and needed to be monitored and assisted as needed for safety. R1 requires routine toileting program. Review of Incident Report (Occurred 07/04/25) indicated that R1 had an unwitnessed fall in R1’s room that resulted in skin tears on both hands, an abrasion on the left knee, and noted hypotension. R1 was transferred to the hospital for further evaluation. Review of Hospital Record (ED Provider Note, 07/04/25) revealed R1’s open right finger wound (laceration with tendon exposed) was repaired using local anesthesia and suturing. R1 was given intravenous antibiotics to prevent infection of the open wound. Interview with Staff #1 (S1) indicated R1 had dinner, watched television in the common area, and then went to R1’s bathroom. S1 indicated R1 was toileting and had an unwitnessed fall. R1 was found on the floor with the walker in front of R1. S1 indicated staff does assist R1 but if R1 goes there [bathroom], R1 will toilet independently. Two out of three caregivers (S10 – S12) working on the second floor at that time indicated they did not assist R1 to the bathroom. The third caregiver could not recall R1's incident nor working that day.

Regarding the allegation, “Due to staff neglect, resident sustained injuries” based on record reviews and interviews, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Civil penalties are being assessed, see LIC421IM. At this time, an additional civil penalty determination is pending in reference to Health & Safety Code 1569.49(f) For a violation that the department determines constitutes physical abuse, as defined in Section 15610.63 of the Welfare and Institutions Code, or resulted in serious bodily injury, as defined in Section 15610.67 of the Welfare and Institutions Code, to a resident.

An exit interview was conducted and plans of correction were developed and a copy this report with appeal rights were left with the Administrator Lourdes Menchaca.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250709112537
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/08/2026
Section Cited
CCR
87468.2(a)(4)
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To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.

This requirement was not met as evidence by:
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The Administrator will create a plan to ensure residents who require toileting assistance are provided with the service by staff. The plan can be emailed to regina.cloyd@dss.ca.gov by the POC due date.
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Based on record review and interviews, on 07/04/2025, R1 was not provided with toileting assistance by staff, resulting in R1's fall and serious injuries, which posed an immediate safety risk to client in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3