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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320053
Report Date: 10/12/2021
Date Signed: 10/12/2021 11:31:07 AM

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
09/09/2021 and conducted by Evaluator Ana Soto
COMPLAINT CONTROL NUMBER: 11-AS-20210909113121
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: 60DATE:
10/12/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jessica Ponce, Health Services, DirectorTIME COMPLETED:
11:30 PM
ALLEGATION(S):
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Facility staff handled resident in a rough manner
Facility staff did not prevent resident's from engaging in an altercation
Facility staff are not ensuring that residents are dressed appropriately
Staff is insufficient to meet resident's needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Jessica Ponce, Director of Health Services.

The investigation consisted of the following: Interviews and Record review. On 09/14/21, LPA Soto conducted interviews with the Jessica, LVN, S#2 - S#6. R#1 - R#6. The LPA toured rooms 104,211,301,304,307, and 309, 1st floor dining room, lounge/TV area, 2nd Floor dining room, lounge/TV area, 3rd floor dining room, lounge/TV area. LPA also requested copies of the following documents: Resident roster, Staff roster, R#1 & R#2 files (face sheet, physician's report, and pre-appraisal), S#6 file w/trainings, Staff work schedule, and training logs (transferring Dementia residents.)
Based on the LPA's investigation, the investigation revealed the following.

For Allegation 1 – Facility staff handled resident in a rough manner. Interviews conducted with Jessica, Director of Health Services, S#3 – S#5, they all stated that they have never witnessed any staff be rough with any resident. They conducted their own investigation and found there were no other similar incidents involving S#6. Jessica also stated that she spoke with S#6 about the incident involving him being allegiantly rough with a resident and advised him that he would need to be retrain on handling Dementia resident. Interview conducted with S#2, stated that she had overheard other staff talking about S#6 being rough with resident, but could not remember who the staff were, and she never witnessed S#6 be rough with residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
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-20210909113121
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: 10/12/2021
NARRATIVE
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Interviews with R#1, R#3, & R#5, could not understand what LPA Soto was asking and kept looking away from LPA Soto. Interviews with R#2 & R#4, stated that staff has never been rough with them or never seen any staff be rough with other residents. Interviews conducted do not concur with the above allegation.

Allegation 2 - Facility staff did not prevent resident's from engaging in an altercation. Interviews conducted with Jessica, Director of Health Services, she stated that they did have 2 residents get into an altercation. She sent in the SIR. Residents fighting is very unusual, the 2 residents were separated immediately and redirected. They did not sustain any injuries. Interviews with S#2 – S#6, stated that they have never seen residents get into any altercations. Interviews with R#1, R#3, & R#5, could not understand what LPA Soto was asking and kept looking away from LPA Soto. Interviews with R#2 & R#4, stated that they have not seen residents fight. Interviews conducted do not concur with the above allegation.

Allegation 3 - Facility staff are not ensuring that residents are dressed appropriately. Interviews conducted with Jessica, Director of Health Services, S#2 – S#6, stated that some of the residents have a behavior that they take their clothes and diapers off. They try to change the diaper themselves; they redirect the residents when that happens and try to let them know not to do that. They can’t remember, so they continue to do it. LPA Soto reviewed resident’s records and they show that some residents do have behaviors with taking their diaper and clothes off. The staff could not control what the residents will do, but the staff does redirected them as soon as they see the residents undressed or without diapers. Interviews with R#1, R#3, & R#5, could not understand what LPA Soto was asking and kept looking away from LPA Soto. Interviews with R#2 & R#4, stated that they have seen residents with no diapers and clothes, did not know who they were. Interviews conducted and records reviewed, do not concur with the above allegation.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20210909113121
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: 10/12/2021
NARRATIVE
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Allegation 4 - Staff is insufficient to meet resident's needs. Interviews conducted with Jessica, Director of Health Services, she stated that they have enough staff to cover all shifts. They are trying to see if more staff is needed, but they are not definite on them hiring extra staff. LPA Soto reviewed records and the facility does have enough staff for all shifts. Interviews with S#2 – S#6 and R#1 – R#6, They all stated that they feel and/or believe there are enough staff to take care of the resident’s needs. Interviews conducted and records reviewed, do 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 Jessica Ponce, Health Services Director, and a hard copy was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3