374604254-3-28-2025-08-AS-CLOZ-DF82EB-20250328171939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604254
Report Date: 03/28/2025
Date Signed: 03/28/2025 05:21:15 PM

Document Has Been Signed on 03/28/2025 05:21 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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:	374604254
ADMINISTRATOR/ DIRECTOR:	SABRINA PEGROSS		FACILITY TYPE:	740
ADDRESS:	335 SAXONY ROAD		TELEPHONE:	(949) 240-7200
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY: 122		CENSUS: 43	DATE:	03/28/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Michelle Neumann, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by concierge Caroline Fitzgerald. LPA discussed the purpose of the visit with Administrator’s Izzy Perez and Michelle Neumann and Kaitlyn Collins, Director of Resident and Family Services (DRFS). According to the facility’s license, there may be a maximum of 122 residents all of whom may be non-ambulatory in at any given time at the facility site with an approval waiver of 25 residents on hospice. Facility is approved for delayed egress and secured locked perimeters. During today’s inspection, the facility’s current census is 68 residents living at the facility. There were 68 residents present at the facility site during the inspection. LPA, accompanied by Administrator Neumann, DRFS Collins and Josue Lopez Director of Plant Operations, toured the interior and exterior of the facility, and inspected residents’ room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required linens and furnishings. Doors, windows, toilets, and showers were all in working order. Extra linens and hygiene supplies are kept in the caregiver linen closet. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 74 degrees Fahrenheit (F). Hot water temperature at taps accessible to residents were compliant: In the Nexus Community, hot water temperature in a random room measured 108 degrees F; kitchen sink measured hot water at 107.8 degrees F; [CONTINUED ON LIC 809-C]

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 374604254
	VISIT DATE: 03/28/2025

NARRATIVE

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[CONTINUED FROM LIC 809]
In the Springs Community, hot water temperature in a random room measured at 111.9 degrees F; community sink measured hot water at 109.9 degrees F; the Pacifica Community, a random room measured hot water at 110.5 degrees F; community sink measured hot water at 112.8 degrees F; the Bluffs Community, a random room measured hot water at 111.7 degrees F; random room #2 measured hot water at 110.8 degrees F; and community kitchen measured hot water at 115.2 degrees F.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present in their main kitchen. Cooking, dining equipment and utensils were present, and all safely stored in their storage area. There were no toxic chemicals or poisons accessible to residents.

Medications were properly labeled, as required, and stored in their locked Wellness Centers. LPA inspected the medication room and found that medications were properly labeled and stored in a locked cart in their locked Wellness Center. The facility-maintained medication logs which LPA reviewed.

The facility did have a pool area that measured up to 4 feet in depth. There was a locked gate that is in good repair which surrounded the pool. The fence was designed and installed to be unremovable and measured more than 5 feet high. The fence was not obscured from sight and there was no door or window which could access the pool area. The openings from the railings did not exceed 4”. The bottom from the ground to the hard surface of the fence did not exceed 2”. No ladder was observed near the vicinity of the pool and the platform is completely in accessible. The fence was thick enough that it could not be easily broken, removed or stretched. Administrator agreed that the fencing will remain in place and properly functioning whenever there are licensed residents in care. Administrator also agreed that ladders will remain inaccessible whenever there are licensed residents in care.

Per Administrator Neumann, no firearms or ammunition are kept at the facility. Carbon monoxide detectors and fire alarms are yearly inspected by their Fire Department and was last inspected on March 10, 2025. Fire extinguishers were present (26) and serviced within the last 12 months. First aid kits were complete and readily accessible in their Wellness Centers. Emergency lighting and facility telephone were all working.

LPA interviewed staff and residents, and reviewed staff and resident records. LPA interviews, with staff and residents, did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility.

[CONTINUED ON LIC 809-C]

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 374604254
	VISIT DATE: 03/28/2025

NARRATIVE

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[Continued from LIC 809-C]

It should be noted that the inspection was interrupted for approximately one hour for a lunch break and resumed promptly at 1PM. During today's visit, there were no deficiencies observed or cited during the annual inspection.

An exit interview was conducted with Administrator Michelle Neumann, Kaitlyn Collins, Director of Resident and Family Services, Keirstin Rodman, Clinical Staff and Office Manager, Kathy Roney, Culinary Director, and Cindy Blenkarn, Director of Health Services. A copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided to Administrator Neumann, at the conclusion of the visit. The signature below confirms the documents were received.

LPA received their updated Plan of Operations to include the updated regulations for RCFE and Dementia. LPA requested Administrator Neumann to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, and Emergency Disaster Plan LIC 610-E to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov.

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025

LIC809 (FAS) - (06/04)

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