198320053-6-3-2023-11-AS-MVAO-CTFUJU-20230705153801

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320053
Report Date: 05/30/2023
Date Signed: 06/03/2023 03:19:54 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
12/14/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221214153729

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: 88	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	02:03 PM
MET WITH:	Lourdes Menchaca, Executive Director		TIME COMPLETED:	02:04 PM

ALLEGATION(S):

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Staff did not keep resident's authorized person informed regarding resident's care.
Staff retaliated against resident for complaining.
Staff did not ensure that resident's dentures were adequately installed.
Staff did not ensure that resident's hearing aide was charged and properly installed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Lourdes Menchaca, Executive Director

The investigation consisted of following: Interviews and Record reviews. On 12/19/22, LPA Montoya interviewed S#1 – Lourdes Montoya – Executive Director and toured the facility with Administrator Lourdes Menchaca. LPA requested a resident roster, staff roster and copies of one resident's (R1) service records: Admission Agreement, Physician’s Report and Appraisal, Medication Administration Records, Nurses Notes, and other pertinent records. On 05/16/23, LPA Soto conducted interviews with S#1 - Executive Director, S#2 - S#9, and R#1 - R#8. The LPA Soto also requested copies of the following documents: Partial file for R#1 (Physician's report, Physician notes, and progress notes.) Resident roster, Staff roster, MARs for (November and December 2022,) and Staff shift schedule for December 2022.

Unsubstantiated

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: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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-20221214153729

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: 05/30/2023

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following:
Allegation 1 - Staff did not keep resident's authorized person informed regarding resident's care. Interviews conducted with staff #1, S#2, S#4, S#6, & S#9, communicated that R#1, family members were always at the facility. There was no way that the family members did not know what was happening with R#1, every time they would come to the facility, there were always asking about R#1 and telling staff what R#1 needed. R#1’s family members were very involved with R#1’s care. S#1 & S#2, also communicated that family members were always either calling or emailing facility about R#1’s care. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation.
Allegation 2 - Staff retaliated against resident for complaining. Interviews conducted with staff #1 – S#9, communicated that they would never do anything like that to any resident for any reason and they would never allow that to happen to any resident, they would report it if they were aware of someone doing that to any resident. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation.
Allegation 3 - Staff did not ensure that resident's dentures were adequately installed. Interviews conducted with staff #1, S#2, S#4, & S#9, communicated that R#1’s dentures were a bit loose, and they informed the family members. They believed they had become loose because R31 had recently lost weight. They did not fit properly. S#1 personally made sure that R31’s dentures were put in properly, cleaned and had enough paste to keep them on. S#1 asked staff to make sure they checked R#1’s dentures before every meal. The dentures would be fine but then they would move, again because they needed to be refitted and family members, never took them to get refitted for R#1. LPA reviewed admission agreement, family members were responsible for R#1’s dentures and their care. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted and records reviewed did not concur with the above allegation.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221214153729

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: 05/30/2023

NARRATIVE

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Allegation 4 - Staff did not ensure that resident's hearing aid was charged and properly installed. Interviews conducted with staff #1, S#2, S#4, & S#9, communicated that R#1’s hearing aid was charged every night, but she could not hear even though, it had been charged and/or exchanged for another one. The family was responsible for providing their residents hearing aid and getting them fixed and/or replaced. The facility would let the family members know about the hearing aid and they would say that they would go and get them fixed, but the hearing aid still had the same problem. Interviews conducted with resident #1 - #8, could not communicated with LPA. LPA reviewed R\#1 admission agreement, and it was the family members responsibility to provide the hearing aids for their resident. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted and records reviewed did 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 Lourdes Menchaca, Executive Director and a hard copy of report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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