198320053-12-24-2021-11-AS-AJKK-CEKUXR-20220519155845

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320053
Report Date: 12/20/2021
Date Signed: 12/24/2021 08:01:37 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
12/14/2021 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20211214170629

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:	12/20/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Lourdes Menchaca & Jessica Ponce		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Facility does not allow resident to choose preferred services
Facility does not assist resident with obtaining medical care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Monday, December 20, 2021. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met with Administrator Lourdes Menchaca and Jessica Ponce. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed staff 1-3 (S1-3) and attempted to interview residents 2-7 (R2-7), all residents interviewed had some form of memory loss and had difficulty answering the questions. LPA Bunker asked questions relevant to the nature of the complaint. LPA Bunker requested and reviewed resident 1's (R1) records. Administrator Lourdes Menchaca and Director of Health Services, Jessica Ponce, LVN, stated resident's daughter doesn't want to follow Silverado's medication policy. Staff stated Silverado makes every effort to keep its residents safe and provide quality medical care to all residents. Staff states they reported the special incident report regarding R1 in a timely manner.
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

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-20211214170629

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: 12/20/2021

NARRATIVE

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Continued LIC9099-C page 2

LPA Bunker requested copies of the following documents: Admission Agreement, Medication Log, Medical Administration Records (MARs), Personal Rights, Identification and Emergency Information, Consent for Emergency Medical Treatment, Replacement Appraisal Information, Physician Orders, Physician's Report for Residential Care for the Elderly (RCFE), Resident Pharmacy Enrollment Form, COVID-19 Vaccination Record Card, Silverado Pharmacy Policy, and Resident Roster

Allegation #1 Facility does not allow a resident to choose preferred services. Staff 1-3 (S1-3) interviewed stated the facility does allow residents to choose their preferred services, the facility requires thirty (30) day supplies of medication. R1 received a new order for medication, staff requested the medication and the daughter said she was busy and would bring it in the next day after multi attempts. The daughter brought in two (2) of R1 medication, Tylenol (10 days late) and tramadol for pain (2 days late), the facility is requesting bubble packs. It helps ensure accuracy and safety for residents. Staff stated uniform packaging of medications allows the nurses to easily be accountable for the large numbers of medications that their residents take. Staff stated R1 can use her own pharmacy, the facility must have the medications in a timely manner. The daughter is using CVS Pharmacy and the facility uses Omnicare Pharmacy and suggested it to the daughter and she stated she prefers CVS because she knows the Pharmacist and likes to visit with him. Staff stated they informed the daughter the facility is responsible if there is a medication error that's why it is important to have the new prescription order filled immediately. Staff stated Silverado Senior Living makes every effort to keep its residents safe and provide quality of care to all residents. As part of their resident safety program, Silverado Senior Living follows a pharmacy policy that requires that all residents obtain their medications through an approved pharmacy that contracts with Silverado and packages all medications in a uniform system. Staff stated they are following Title 22 Regulations regarding medication.

See continued LIC9099-C page 3

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20211214170629

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: 12/20/2021

NARRATIVE

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Continued LIC9099-C page 3

Allegation #2 Facility does not assist a resident with obtaining medical care. Staff 1-3 (S1-3) interviewed stated the facility does assist R1 with medical care. Staff stated Silverado Senior Living makes every effort to keep its residents safe and provide quality of medical care to all residents. R1 daughter suggests staff use force when they are performing a range of motion therapy on R1 arms. Staff stated this is not a skilled nursing facility. They do not perform physical therapy at Silverado Senior Living-Beach Cities. The facility staff doesn't want to cause R1 any pain or injury and is following R1 physician's orders. Staff stated R1 may need a higher level of care. LPA Bunker observed the special incident report dated 12/17/2021 regarding R1 arms that were self-reported by the facility staff in a timely manner. Staff stated they are providing R1 with the necessary care and supervision. According to Title 22 Regulations.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC 9099, LIC9099-Cs, and Confidential Names LIC 811 was provided to Administrator Lourdes Menchaca

There were no deficiencies cited.

Exit interview conducted

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

LIC9099 (FAS) - (06/04)

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