198603266-4-15-2023-11-AS-EDAT-CQWAMJ-20230415002048

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603266
Report Date: 04/14/2023
Date Signed: 04/15/2023 12:20:59 AM

Document Has Been Signed on 04/15/2023 12:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SILVERADO SENIOR LIVING-BEVERLY PLACE		FACILITY NUMBER:	198603266
ADMINISTRATOR:	GIUNTO, TAYLOR		FACILITY TYPE:	740
ADDRESS:	330 N. HAYWORTH AVE		TELEPHONE:	(323) 852-9200
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	256	CENSUS: 111	DATE:	04/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Vida Gwinn & Taylor Guinto		TIME COMPLETED:	04:29 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 04/14/23, Licensing Program Analyst (LPAs) Ernand Dabuet, Wendy Gibbs, and Mario Leon conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Vida Gwinn and Director of Health Services Jean DeGuzman. LPA Dabuet explained the purpose of today’s visit. The facility is licensed to operate for (256) non-ambulatory elderly adults of which (92) may be bedridden ages 60 and above. Currently, the facility has (111) residents and (13) in hospice care. The facility is approved for (36) hospice residents. The facility is a three-story structure located in a residential neighborhood. It consists of the following: (114) residents' rooms, (114) bathrooms (12) guest restrooms, a lobby, a theater, a gym, a library, a beauty salon, a dining area, a kitchen, a spa, a bistro, (2) wellness rooms, a game room, outside courtyards, and a parking garage. LPAs toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were stocked during the visit. The resident rooms were inspected: #103, #104, #107, #149, #152 #203, #231, #234, #235 #246, #247, #312, #319, #335, #351, and #344. Bathrooms were operational with water temperature measured at 105.7 – 117.3 degrees F. A comfortable temperature was maintained in the facility at 72 - 74 degrees F. LPAs observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Evaluation Report continues LIC 809-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SILVERADO SENIOR LIVING-BEVERLY PLACE	FACILITY NUMBER: 198603266
	VISIT DATE: 04/14/2023

NARRATIVE

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Fire extinguishers were charged, and smoke detectors and carbon monoxide were operable in each resident's room. A review of the Medication Records Administration (MAR) was observed to be maintained in order and accurately. During the visit, LPAs observed the facility's infection control practices. LPAs observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPAs observed multiple First Aid Kit maintained in order and complete. LPAs observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

LPAs conducted an audit of resident #1-#7 (R1-R7) service files, and staff #1-#7 (S1-S7) personnel files were in order and complete. LPAs Gibbs and Leon conducted (6) resident and (5) staff interviews. LPAs Gibbs and Leon conducted (6) resident and (5) staff interviews.

No deficiencies during this inspection visit.

An exit interview was conducted with Vida Gwinn and a copy of the report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

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