198320053-11-10-2022-11-AS-JHAD-CM4QLZ-20221214111646

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320053
Report Date: 11/09/2022
Date Signed: 11/10/2022 08:07:35 AM

Substantiated

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
11/02/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221102103140

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: 75	DATE:	11/09/2022
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Jessica Ponce, Director of Health Services		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility prohibiting resident from having visitors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted an initial complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Jessica Ponce, Director of Health Services.

The investigation consisted of following: Interviews and Record reviews. On11/09/22, LPA interviewed S#1 - Jessica Ponce - Director of Health Services, S#2 - S#8, R#1 - R#7. Toured the 1st floor rooms # 113A & B, 108A, 112A, lounges, & living room. 2nd floor dining room, lounge, and office. LPA Soto received the following documents on 11/09/22: Resident Roster, Staff Schedule, Face sheet, Admissions agreement, Consent to release confidential information, POA document dated 07/11/18, Physician's Report, Pre-Appraisal, and Police report #221028082.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

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-20221102103140

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: 11/09/2022

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following.
Allegation 1 – Facility prohibiting resident from having visitors.
Interviews conducted with S#1, communicated that she was attempting to explain to the family member and POA for resident, that she was going to connect family member with upper management, so they could speak to family member about family members concerns. Family member yelled and screamed at S#1. S#1 repeatedly asked family member to leave, because she was causing a scene and making the residents very uncomfortable. Family member continued to yell and scream at S#1. S#1 was going to call the front desk to have them call the police, when family member lunged at S#1. S#1 backed away from family member and advised family member that type of behavior was not appropriate. Police arrived and removed family member from facility. Interviews conducted with S#2 – S#5 communicated that they did not witness the incident, but did know that family member is restricted from coming to facility. Interviews conducted with S#6 - S#8, communicated that they witnessed the incident in question and also know that family member is restricted from coming to facility. LPA reviewed SIR dated 11/04/22, were S#1 wrote that R#1 family member was not being allowed to visit or go into facility. CCLD received an email dated 10/28/22, where Silverado Beach Cities – writes to family member, they will not be allowed to enter the facility for the next couple weeks. AB 937 prohibits the facility from restricting visitors from residents. The interviews and records reviewed concur with the above allegation.

Based on LPA’s observations and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation.

An exit interview was conducted with Jessica Ponce, Director of Health services a hard copy of report was provided along with Appeal Rights.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20221102103140

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/09/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 11/11/2022 Section Cited CCR 87468.1	1 2 3 4 5 6 7	To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice.....This was met as evidence by: Based on SIR & Email, restricting visits. Which poses a potential health and safety risk for all persons in care.	1 2 3 4 5 6 7	Executive Director shall create a plan that insures that in the future, they don't restrict residents visitor's.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

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