374603165-10-4-2023-08-AS-SJAB-CX4VYG-20231030165104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603165
Report Date: 10/04/2023
Date Signed: 10/04/2023 03:58:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2020 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20200528102856

FACILITY NAME:	SILVERADO SENIOR LIVING - ENCINITAS		FACILITY NUMBER:	374603165
ADMINISTRATOR:	JOHNSON, MARIVEL		FACILITY TYPE:	740
ADDRESS:	335 SAXONY RD		TELEPHONE:	(760) 753-1245
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	0	CENSUS: 0	DATE:	10/04/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Report Mailed to Licensee via USPS Certified Mail		TIME COMPLETED:	12:01 PM

ALLEGATION(S):

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Lack of supervision resulting resident(s) falling while in care
Staff not assisting resident(s) in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong sent this report to former licensee’s last known address via USPS certified mail.

On May 28, 2020, Community Care Licensing (CCL) received a complaint alleging lack of supervision resulted in residents falling while in care and staff were not assisting residents in a timely manner.

During investigation, the Department collected available records as well as facility documentation and conducted interviews. According to allegation, residents were being left alone due to lack of staff resulting in falls, but no injuries were reported. According to interviews, the facility did not have a shortage of staff and all falls were reported to the Department. Interviews did not reveal any specific incidents of residents falling due to lack of supervision. Interview with outside source did not reveal any additional information. Additionally, there were no records to corroborate allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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 08-AS-20200528102856

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SILVERADO SENIOR LIVING - ENCINITAS	FACILITY NUMBER: 374603165
	VISIT DATE: 10/04/2023

NARRATIVE

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It was also alleged that staff were not assisting residents in a timely manner. Interviews revealed that staff response time to residents was usually within 5 minutes. Records collected revealed that during the morning shift there were 18 staff available to the 101 census, the afternoon shift revealed there were 16 staff available to the 101 census and the night shift had 9 staff available to the 101 census. Interview with outside source did not reveal any corroborating evidence to allegation.

Based on the Departments interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. A a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to former Licensee, via USPS Certified mail.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC9099 (FAS) - (06/04)

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