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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603165
Report Date: 12/16/2023
Date Signed: 12/16/2023 02:19:30 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
09/23/2020 and conducted by Evaluator Nacole Patterson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20200923094407
FACILITY NAME:SILVERADO SENIOR LIVING - ENCINITASFACILITY NUMBER:
374603165
ADMINISTRATOR:JOHNSON, MARIVELFACILITY TYPE:
740
ADDRESS:335 SAXONY RDTELEPHONE:
(760) 753-1245
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:0CENSUS: 0DATE:
12/16/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Facility Closed- Report Mailed to Last Address on FileTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility is restricting visitation.
INVESTIGATION FINDINGS:
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The following determination of findings has been made by Licensing Program Analyst (LPA) Nacole Patterson regarding the above allegation. The facility closed on March 3rd, 2021, due to a change of ownership, and this report was mailed to the last known address on record for the former licensee regarding the findings.

On 9/23/2020 it was alleged that the Licensee restricted visitation by not allowing Resident 1 (R1) to visit privately with outside individuals and authorized parties. The Department’s investigation consisted of a virtual facility visit (due to Covid-19 restrictions), review of relevant records, and interviews with facility staff and outside sources. Staff interview revealed concerns and a lack of proof regarding the legal Power of Attorney (POA) for R1; the Licensee made attempts to protect the resident from suspected abuse, which resulted in the ED not allowing the resident in question to sign paperwork at the facility.

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20200923094407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SILVERADO SENIOR LIVING - ENCINITAS
FACILITY NUMBER: 374603165
VISIT DATE: 12/16/2023
NARRATIVE
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(Continued from LIC9099)

Records review revealed that actions taken by the Licensee regarding other resident visitation and communication with authorized parties were done in good faith, in an attempt to protect resident(s) from abuse and infectious diseases. Records review further revealed that the Licensee took action by contacting the Ombudsman and Adult Protective Services to protect the resident. Outside sources did not respond for interview.

Based on interviews and records review, the investigation did not yield sufficient evidence to conclude that the Licensee restricted visitation, therefore the allegation is UNSUBSTANTIATED. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were mailed to the last known address on file for the facility.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2