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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603165
Report Date: 02/26/2024
Date Signed: 02/26/2024 01:38:57 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
07/16/2020 and conducted by Evaluator Carmen Lopez
COMPLAINT CONTROL NUMBER: 08-AS-20200716110809
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: 74DATE:
02/26/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Marivel Johnson, Executive DirectorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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- Staff refused to allow residents to choose their own pharmacy.
- Staff refused to allow the residents to talk to the Ombudsman.
- Facility did not issue refund to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver a complaint investigation regarding the above mentioned allegations. LPA identified herself and was granted entry by Jeff Keast, front desk. LPA stated the purpose of the visit and reviewed the findings of the complaint with Executive Director Marivel Johnson.

The Department’s investigation consisted of interviews with staff, and records review of relevant documents pertinent to this investigation. On July 16, 2020, it was alleged that the facility staff refused to allow residents to choose their own pharmacy; staff refused to allow the residents to speak to the ombudsman; and facility did not issue refund to resident.

(Continuation on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) -34-3976
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
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 3
Control Number 08-AS-20200716110809
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: 02/26/2024
NARRATIVE
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(Continuation of LIC9099)

It was specifically alleged that the facility refused to let the residents use their own pharmacy and had to use the facility’s preferred pharmacy. Interview with the Executive Director said that they allow residents to use their own Pharmacy of choice but recommend their preferred pharmacy. They do have residents who opted to be a part of their own preferred pharmacy that is not the facility’s preferred pharmacy. According to the ED, residents are up-charged for using another pharmacy but no bill. According to staff #1 (S1) interviewed, they said that families are given the option to choose their preferred pharmacy upon admission. During their admission, they are provided two forms; one form is the pharmacy policy to opt for their preferred pharmacy; and the second form is for the facility’s preferred policy. Depending on the families and or residents’ decision, the facility will follow their preference. S1 did not recall a time where families opted to use another pharmacy as the facility does charge a $300 fee. Families are usually charged the co-pay fee’s and the $300 fee if they opted to use their own pharmacy. A review of records revealed that upon the admission of resident #1 (R1) and resident #2 (R2) there were documents that that enrolled each of them to the facility's preferred pharmacy. The power of attorney (POA) for R1 was R2, who agreed and signed the enrollment form Resident Pharmacy Enrollment forms. On 2/23/20, R2 signed the Resident Pharmacy Enrollment Form, for both themselves and R1 - as their financially responsible party. On the same form, it was annotated that R1 had a financially responsible party named who agreed to be responsible for payment of all amounts owed by the resident for prescription drug products and service provided to the resident by the facility's preferred pharmacy. R1’s financially responsible party for their pharmacy needs was R2 with persons involved in R1’s healthcare who had permission to manage the resident’s prescriptions. Based on the information obtained there is not sufficient evidence to support the allegation.

It was specifically alleged that staff were unable to provide the residents’ family with the contact information of the Long-Term Care Ombudsman (LTCO). A review of records, specifically former required annual inspections, the facility was not cited for not having required postings which includes the LTCO posting(s). Upon review of the resident’s admission agreement for R1 and R2, specifically appendix c – Statement of Residents Personal Rights, the contact information for the LTCO was provided in two sections of the appendix and was signed by the responsible party and dated 2/24/2020. During the initial visit on 07/21/2020, LPA Lott photographed two framed LTCO postings and the postings included contact information for the LTCO. One framed posting was located next to an elevator and the second framed posting was located in a hallway next to the metal Silver Springs sign. It was also documented that the Community Care Licensing framed posting was located in the front receptionist area posted on a column with contact information. Based on the information obtained there is insufficient evidence to support the allegation.

(Continuation on LIC9099-C)
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) -34-3976
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20200716110809
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: 02/26/2024
NARRATIVE
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(Continuation of LIC9099-C)

It was specifically alleged that the facility did not have R1 and R2’s payments up to date and showed an outstanding balance when a refund should have been allotted for R1 and R2 as their payments were made in advance. A review of records revealed that the residents were admitted to the facility on a short-term stay basis. The admission agreement did not specify the length of time for their stay. According to the agreement, residents were admitted under a voucher that was charged to a third-party vendor for the care of two residents at a rate of $285 per day, for specified dates. The residents move-in date was on 2/24/2020. The residents were not covered by the voucher on their move-in date until the following day. The facility and the family agreed to the amount of $294 per day to be charged to stay at the facility. The voucher only covered certain dates during R1 and R2’s stay at the facility, which included both care receivers. The final move out date was on 05/18/2020. According to the facility notes, the family owed $294. In review of the vouchers and the admission agreement for both R1 and R2, the amount to be charged for the two residents to stay at the facility totaled $24,585.00 only for the room rate. According to the facility spreadsheet of the amounts paid to the facility, it did not total to the amount owed. Based on the information obtained there is insufficient evidence to support the allegation.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff interviews, and records reviewed there is not sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated.

The report was discussed, and an exit interview was conducted with Executive Director Marivel Johnson. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Executive Director Johnson at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) -34-3976
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3