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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603165
Report Date: 01/23/2024
Date Signed: 01/23/2024 08:07:54 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-20200923112053
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:
01/23/2024
UNANNOUNCEDTIME BEGAN:
07:00 PM
MET WITH:Facility Closed- Report Mailed to Last Address on FileTIME COMPLETED:
08:00 PM
ALLEGATION(S):
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9
Staff did not ensure that resident's diapering needs were met.
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 staff did not ensure that residents' (R1, R2) diapering needs were met. 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 that R1 was changed and/or checked for incontinence every 2 hours or more frequently depending on needs. Staff interview revealed that the facility did not track resident diapering/changing. R1 and R2 were unable to be interviewed. Outside source interview revealed no concerns with the care being provided at the facility. Records review revealed that staff followed R1's care plan regarding incontinence care.
Continued on LIC9099-C p.2
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: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
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-20200923112053
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: 01/23/2024
NARRATIVE
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Continued from LIC9099 p.1

Records further revealed that staff observed the medical concern in question at onset and assisted R1 in receiving medical care the same day. Records review confirmed that staff notified R1's physician and responsible party immediately. Information regarding R2 was unavailable due to the timeframe for resident record retention being exhausted.

Based on interviews and records review, the investigation did not yield sufficient evidence to conclude that resident diapering needs went unmet, therefore the allegation is UNSUBSTANTIATED. 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: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2