198320053-12-21-2021-11-AS-MVAO-CEZNA5-20220602101657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320053
Report Date: 12/21/2021
Date Signed: 12/21/2021 07:40:55 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
12/14/2021 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211214153013

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:	12/21/2021
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Administrator - Lourdes Menchaca/Director Health Services - Jessica Ponce		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff refrained resident from activity.

INVESTIGATION FINDINGS:

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On 12/21/2021 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Administrator Lourdes Menchaca and Health Services Director Jessica Ponce.

The investigation consisted of the following: LPA Senaha requested and received resident roster, staff roster and other service documents on 12/21/2021. LPA Senaha interviewed residents (R1-R9) and staff (S1-S7).

A plant inspection of the facility was conducted.

Investigation revealed:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

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-20211214153013

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: 12/21/2021

NARRATIVE

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Allegation: Facility staff refrained resident from activity.

It is alleged that the facility staff refrained resident from activity. Residents (R4-R9) did not have any concerns regarding the care and supervision being provided to them by the staff. Residents (R1-R3) were non-verbal. LPA observed residents (R1-R3) in dining area for lunch. Residents (R4–R9) stated they have never been told they cannot leave the facility with a family member. Residents (R4-R9) stated they are offered and encouraged to participate in activities every day. Residents (R4-R9) stated they have never been told they cannot participate in an activity offered by the facility.

Staff (S1-S7) stated family members can take a family member out of the facility as long as the family member follows the facility protocols. Staff (S1-S7) stated they make sure they get all the residents out of bed each day. Majority of the staff stated they get the residents out of bed for breakfast, shower or change in the morning. Staff (S1-S7) stated there is an activity coordinator and the residents are encouraged to participate in activities each day. Majority of the staff stated the residents exercise or residents that are non-ambulatory are scheduled for sensory activities such as sound, taste, feel, massage and range of motion to keep the body moving and blood flowing. Majority of the staff stated they do take residents out in the afternoon whether permitting to get some fresh air. LPA obtained monthly activities calendar showing the activities by the hour each day. LPA observed activities calendar posted on each floor. LPA observed activities calendar at the front desk/lobby area for visitors to take.

Based on LPA’s observation, interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

There were no deficiencies found at the time of the visit.

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

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

LIC9099 (FAS) - (06/04)

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