374604254-10-16-2023-08-AS-DPOL-CX5MS4-20231031095121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604254
Report Date: 10/13/2023
Date Signed: 10/16/2023 07:58:06 AM

Substantiated

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
10/06/2023 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20231006152308

FACILITY NAME:	SILVERADO SENIOR LIVING-ENCINITAS		FACILITY NUMBER:	374604254
ADMINISTRATOR:	JOHNSON, MARIVEL		FACILITY TYPE:	740
ADDRESS:	335 SAXONY ROAD		TELEPHONE:	(949) 240-7200
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	122	CENSUS: 77	DATE:	10/13/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Marivel Johnson, Executive Director		TIME COMPLETED:	05:05 PM

ALLEGATION(S):

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- Facility employed staff without background clearance

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by Marisa Hatcher, Business Office Coordinator. 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 October 6, 2023, it was alleged that the facility employed staff without a background clearance.

It was specifically alleged that between June 2023 through October 2023, the facility did not obtain appropriate criminal background clearance for staff. Interview with staff said the facility received an exemption letter from the Department after a staff was cleared to work around June 2023.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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-20231006152308

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: 374604254
	VISIT DATE: 10/13/2023

NARRATIVE

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After staff read the letter, staff was unclear and unsure who would need to process the exemption, staff or the facility. The letter was received July 2023. Staff confirmed that the staff person worked at the facility after the exemption was received, from July 2023 – October 2023. A review of staff records revealed that the facility received the exemption letter July 2023. The letter does inform the facility that the individual was disqualified from obtaining a background clearance. A review of staff schedules confirmed that the staff worked between the months of July 2023 through October 2023, at the facility. On October 13, 2023, LPA observed that the staff was not present at the time of the investigation.

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff interview, records reviewed, and LPA observations, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099-D.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Administrator 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: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20231006152308

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: 374604254
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/27/2023 Section Cited CCR 87355(e)(3)	1 2 3 4 5 6 7	87355 (e)(3) Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing, or volunteering in a licensed facility: (3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility. … this requirement was not met as evidence by:	1 2 3 4 5 6 7	Administrator will conduct training with staff regarding all exemption requests and clearances sent forth by the Department by POC due date, 10/27/23.
	8 9 10 11 12 13 14	Based on interviews and records reviewed, staff did not obtain an approved criminal exemption request prior to continue working at the facility. This posed a potential safety risk to 77 of 77 residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC9099 (FAS) - (06/04)

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