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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604255
Report Date: 04/23/2024
Date Signed: 04/23/2024 09:31:57 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/19/2021 and conducted by Evaluator Amy Domingo
COMPLAINT CONTROL NUMBER: 08-AS-20211119083204
FACILITY NAME:SILVERADO SENIOR LIVING-ESCONDIDOFACILITY NUMBER:
374604255
ADMINISTRATOR:MCMILLON, TANAFACILITY TYPE:
740
ADDRESS:1500 BORDEN ROADTELEPHONE:
(760) 737-7900
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:104CENSUS: 61DATE:
04/23/2024
UNANNOUNCEDTIME BEGAN:
11:33 AM
MET WITH:Michael Zulettal AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Licensee did not accord resident with safe accommodations
Facility did not safeguard resident's personal property
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA Domingo introduced herself and disclosed the purpose of the visit to Administrator Michael Zuletta.

The Department’s investigation consisted of unannounced facility visits, review of facility records and interviews with outside source and facility staff.

On 11/19/2021 it was alleged that Licensee did not accord resident with safe accommodations. During the investigation three (3) witnesses verified that staff members followed policy regarding providing safe accommodations for the resident. S1 and OS1 were called to maintain the safety of the resident.

(Continued on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
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-20211119083204
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: SILVERADO SENIOR LIVING-ESCONDIDO
FACILITY NUMBER: 374604255
VISIT DATE: 04/23/2024
NARRATIVE
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(Continued from LIC9099)


It was alleged that the facility did not safeguard resident's personal property.  Interviews with S1 through S3 confirmed that resident's personal property was removed and accounted for by OS1.  OS1 confirmed that resident's personal property was accounted for and returned to the resident.

Based on interviews and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED.  An exit interview was conducted with Administrator Michael Zuletta to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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