306005693-10-27-2023-22-AS-AORZ-CXEVC6-20231109151837

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005693
Report Date: 10/27/2023
Date Signed: 10/27/2023 01:09:27 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
10/23/2023 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231023094358

FACILITY NAME:	SILVERADO SENIOR LIVING- NEWPORT MESA		FACILITY NUMBER:	306005693
ADMINISTRATOR:	HEATHER YOUNAN		FACILITY TYPE:	740
ADDRESS:	350 W BAY STREET		TELEPHONE:	(949) 631-2212
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92627
CAPACITY:	82	CENSUS: 59	DATE:	10/27/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Heather Younan		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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facility charging for un-needed services

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit to iniiate complaint investigation into the above allegations. LPA explained the reason for the visit with Administrator Heather Younan.

During the visit LPA toured facility, conducted interviews and requested pertinent documentation such as Admission Agreement, Service Plan, Physician's report, Notification letter and Routine Wellness form. LPA made observations of residents relaxing in common areas and relaxing inside bedrooms.
Investigation revealed the following, Resident 1 (R1)’s recent Physician’s report dated 5/1/2023 indicated in the area of capacity for care, R1 was able to bathe and self dress requiring some assistance. Based off interviews R1 came into facility back in 2016 requiring little assistance at the time. R1’s is diagnosed with Alzheimers.Staff Interviews indicated R1 has slowly progressed the past 7 years and recently has had increased confusion resulting in additional assistance. R1’s service plan was updated on 7/12/2023. Investigation revealed that Facility conducts monthly Routine Wellness Assessments. CONTINUED 9099C
.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

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 22-AS-20231023094358

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SILVERADO SENIOR LIVING- NEWPORT MESA	FACILITY NUMBER: 306005693
	VISIT DATE: 10/27/2023

NARRATIVE

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Routine Wellness Result for 6/30/2023 indicated R1 was fully independent of peri care. The Routine Wellness Results from 7/31/2023 to 9/29/23 notated resident’s assessment for peri care indicated R1 had changes to bladder incontinence and is no longer independently managed. Interviews also revealed that R1 can go to bathroom on their own however staff help assist resident with incontinence care by cleaning and changing resident after resident has had bowel movements. Interviews revealed that R1 needs assistance with wiping after using restroom.

On 8/29/2023 facility sent out notification letter, notifying responsible party of R1’s change in peri care requiring incontinence care and beginning 9/1/2023 facility was implementing a charge for monthly incontinence care. Resident Billing Invoice statements indicated no incontinence charges were applied to bills for the months of June to September of 2023. Resident’s Billing Invoice dated 10/1/2023 shows an incontinence care charge was billed for the period of 9/1/23 to 9/30/23 as well as statement for care provided 10/1/23 to 10/31/23. Interviews revealed that residents account is enrolled to autopay. Invoice statements confirm resident’s account is currently paid up to date with no balances pending. Interviews revealed that at the request of responsible party, facility is in process of reimbursing resident’s account due to improper notification in person.

Based on interviews conducted and documents revealed, allegation facility charging for un-needed services is deemed Unsubstantiated. Although the allegations may have happened or may be valid; there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Administrator and a copy of this report was provided at the time of exit.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC9099 (FAS) - (06/04)

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