306004350-7-13-2020-22-AS-AORZ-BRJQYT-20200715123537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004350
Report Date: 07/13/2020
Date Signed: 07/13/2020 03:49:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200504120853

FACILITY NAME:	SILVERADO SENIOR LIVING - SAN JUAN CAPISTRANO		FACILITY NUMBER:	306004350
ADMINISTRATOR:	BROWN, DEBORAH		FACILITY TYPE:	740
ADDRESS:	30311 CAMINO CAPISTRANO		TELEPHONE:	(949) 240-0550
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	96	CENSUS: 76	DATE:	07/13/2020
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	William Boles		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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facility failed to provide hospice care in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre contacted the facility via telephone to deliver findings on a complaint investigation due to COVID-19 and pre-cautionary measures. LPA identified himself and discussed the purpose of the call and the elements of the allegation with Executive Director. During the investigation, LPA Alejandre interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as medical records and facility schedules. Regarding the allegation; facility failed to provide hospice care in a timely manner, it was alleged that Resident 1 (R1) should have been put on hospice six months prior to the resident passing on 5/3/2020. Based on a review of the facility and medical records of R1 the resident did have medical issues but there were no indications reported by the staff or in the medical records such as, lack of appetite, weight loss or other issues that would have prompted a hospice evaluation. Interviews with staff and medical professionals treating R1 reported that up until 4/29/2020 R1 was ambulating, and continuing all activities of daily living and was not declining so hospice was not required. On 4/29/2020 staff reported to R1's primary care physician (PCP) that R1's health could be declining and should be evaluated for hospice care. The PCP reported that hospice is not automatic and the patient must be evaluated.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2020

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 22-AS-20200504120853

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SILVERADO SENIOR LIVING - SAN JUAN CAPISTRANO	FACILITY NUMBER: 306004350
	VISIT DATE: 07/13/2020

NARRATIVE

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The PCP reported that in this case he wanted to verify the resident was declining in overall health and was not just suffering from an infection which had been the case previously (on 4/09/2020), on 4/29/20 PCP ordered an X-Ray and for the resident to be weighed. The X-Ray was completed. R1's condition did not change until 5/2/2020. Staff reported to the PCP that R1's condition had declined. On 5/2/2020 R1 was put on hospice. R1 passed away on 5/3/2020. The facility and the PCP followed the condition of R1 and kept note of changes in condition. When the condition of R1 changed the staff and the PCP took action based on the information received and the medical history of R1. There is no evidence to indicate that R1 required hospice prior to 5/2/2020. Based on the information gathered from interviews and the review of medical records, the allegation, facility failed to provide hospice care in a timely manner, is deemed unfounded, meaning the Department has found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the allegation. An exit interview was conducted with the Executive Director William Boles via telephone and a copy of this report was provided to Executive Director William Boles via email and an electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2020

LIC9099 (FAS) - (06/04)

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