198603266-4-11-2024-11-AS-ECES-D47S8T-20240410133942

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603266
Report Date: 04/10/2024
Date Signed: 04/11/2024 06:33:31 AM

Document Has Been Signed on 04/11/2024 06:33 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	SILVERADO SENIOR LIVING-BEVERLY PLACE		FACILITY NUMBER:	198603266
ADMINISTRATOR:	GIUNTO,TAYLOR L.		FACILITY TYPE:	740
ADDRESS:	330 N. HAYWORTH AVE		TELEPHONE:	(323) 852-9200
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	256	CENSUS: 112	DATE:	04/10/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Regional Director of Operations/Administrator (A1: Taylor Giunto) and Administrator/Family Ambassador (A2: Stephanie Brynjolfson).		TIME COMPLETED:	02:00 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	Licensing Program Analysts (LPAs)/Retired Annuitants (RAs) Sparkle Day and Elizabeth Ceniceros conducted an unannounced Annual Random site visit using the CARE Inspection Tool. LPAs/RAs conducted a risk assessment with Staff #2 (S2: Jasmine Garcia). Staff #2 informed LPAs/RAs that the facility has no COVID cases nor do the residents or staff have symptoms. LPAs/RAs met with the Director of Operations/Administrator (A1: Taylor Giunto), Staff #1 (A2: Stephanie Brynjolfson, Family Ambassador), and Staff #3 (S3: Maria Diaz-Anna, Assistant Director of Health Services). LPAs/RAs explained the purpose for 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 (112) residents and (14) 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, two (2) elevators (north and south) and underground parking. LPAs/RAs Day and Ceniceros toured the facility and observed residents in care. There were no bodies of water on the premises. The following residents’ rooms were inspected: #133, #145, #146, #217, #219, #220, #242, #248, #318, #325, #324. Bathrooms were operational with water temperature measuring at 107F – 112F degrees. LPAs/RAs observed beds and bedding supplies to be in good condition, adequate lighting, and sufficient storage for residents’ personal belongings. Bed linens, comforters, and bath towels are fully stocked and stored in cabinets. There is a comfortable room temperature maintained in the facility within 74.0F – 76.0F degrees. LPAs/RAs Day and Ceniceros observed the facility to be furnished at the time of this visit. Storage areas for

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024

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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SILVERADO SENIOR LIVING-BEVERLY PLACE	FACILITY NUMBER: 198603266
	VISIT DATE: 04/10/2024

NARRATIVE

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personal hygiene, cleaning supplies, toxins, and sharp objects were stored and inaccessible to residents in care. The commercial-size kitchen was inspected and there is a sufficient food supply of perishables and non-perishables.

Facility’s smoke detectors and carbon monoxide systems are inter-connected (w/back-up battery) can be observed in the hallways and rooms. LPAs/RAs observed a pull-switch, fire alarm sounding device observed in the hallway/main entrance. Fire extinguishers are fully charged with posted signs. First-aid kits are fully stocked (w/first-aid manual). The last fire drill was conducted on 02/23/24.

LPAs/RAs Day and Ceniceros reviewed Residents #1 - #11 Medication Records Administration (MAR) and observed the MAR to be maintained in an electronic health records system. LPAs/RAs observed the facility's infection control practices and also the screening protocols for visitors, staff, and residents. LPAs/RAs observed: sanitizing stations in common areas and restrooms; multiple first-aid kits maintained in order and complete with required items; a 30-day supply of Personal Protective Equipment (PPE); and all mandated inspection control posters posted at the main entrance. LPAs/RAs Day and Ceniceros conducted an audit of Residents (R1 - R11) records and Staff (S1 - S11) personnel files/training records that are in complete order. LPAs/RAs conducted random interviews of five (5) residents and five (5) staff members.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPAs/RAs did not observe deficiencies, therefore no citations were issued at this time.

An exit interview was conducted and a copy of the Facility Evaluation Report was provided to the Regional Director of Operations/Administrator (A1: Taylor Giunto) and Family Ambassador/Administrator (A2: Stephanie Brynjolfson).

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024

LIC809 (FAS) - (06/04)

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