Silverado Senior Living-Beach Cities

Type of visit: Required - 1 Year

On 07/17/23, Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with DHS Jessica Ponce as the purpose of today’s visit was explained. The facility is licensed to serve 120 non- ambulatory residents ages 60 and over and have a hospice waiver for 30. The current census is 86. The facility is a (4) four story structure located in a commercial building in a residential neighborhood. The facility consists of; (110) bedrooms, (71) bathrooms, 1st floor, 2nd floor, 3rd floor, and 4th floor are mirror image of themselves. all the floors contain lounge / movie room, kitchenette, clean linen rooms, mechanical rooms, activities/dining room. activities storage room, wellness room, nursing supplies, laundry chute room. 1st floor has a fireplace in lounge room, shaded side yard with gazebo, plants, and play area, 2nd floor has an incontinence room/staff lounge, and 4th floor has PT/gym room. The basement has (kitchen, laundry room, and PPE storage.) LPA conducted a records review of 8 staff record, 8 resident records and medication Administration Records, LPA did not observe any discrepancies at the time of visit. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire drill was conducted on 05/06/23, fire extinguishers fully charged were observed throughout facility, carbon monoxide detectors observed, smoke detectors are operational, and a landline was observed. All resident rooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathrooms were found to be within Title 22 regulation, toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F.. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Toxins and knifes were observed to be locked and inaccessible to residents. Exits/ Walkways around the facility were free of debris and hazards. During today’s visit no discrepancies were cited. Exit interview conducted with DHS Jessica Ponce, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 17, 2023

Allegation investigated: Facility fire alarm system not working properly. Facility is in disrepair. Facility staff failed to administer medications as prescribed.

This report supersedes report dated 05/30/23 & report dated 06/23/23.Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Lourdes Menchaca, Executive Director. The investigation consisted of following: Interviews and Record reviews. On 12/19/22, LPA Montoya interviewed S#1 – Lourdes Montoya – Executive Director and toured the facility with Administrator Lourdes Menchaca. LPA requested a resident roster, staff roster and copies of one resident's (R1) service records: Admission Agreement, Physician’s Report and Appraisal, Medication Administration Records, Nurses Notes, and other pertinent records. On 05/16/23, LPA Soto conducted interviews with S#1 - Executive Director, S#2 - S#9, and R#1 - R#8. The LPA Soto also requested copies of the following documents: Partial file for R#1 (Physician's report, Physician notes, and progress notes.) Resident roster, Staff roster, MARs for (November and December 2022,) and Staff shift schedule for December 2022. Unsubstantiated Based on the LPA's investigation, the investigation revealed the following. Allegation 1 - Facility fire alarm system not working properly. Interviews conducted with S#1, S#2, S#4, S#3, communicated that the fire alarm had been going off, but the building (beach cities -health district) had the problem with the fire alarm. Silverado side had no issues with the fire alarm. The Silverado side could hear the alarm, but the beach cities side of the building had the issue, and they were working on resolving the fire alarm problem. Interviews conducted with resident #1 - #8, could not communicated with LPA. The entire building is named Beach Cities-health District. When Silverado leased the building space, they named themselves Silverado Beach Cities to separate themselves from the rest of the building. They just added their name to the buildings name. Therefore, there are two side to the entire building, the Silverado side and the Beach Cities-Health district side. Interviews conducted did not concur with the above allegation. Allegation 2 - Facility is in disrepair. Interviews conducted with staff #1 – S#9, communicated that the facility did not have problems with the lights in the common areas. S#1, S#2, and S#4 do not recall if R#1 rooms needed light bulbs or not, they can’t remember. S#1 – S#9, also communicated that if anytime any light bulbs are needed, maintenance will replace them right away as soon as it’s reported. The facility is in great condition, maintenance is real good at fixing anything that needs repair. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation. Allegation 3 - Facility staff failed to administer medications as prescribed. Interview conducted with S#9, communicated that they spoke with R#1 family member and informed them that they had not administered R#1 medication personally, someone had given R#1 medication, but they were not sure who had administered R#1 medication, they had to look at R#1 chart to see who administered medication. RP, misunderstood S#9, that they had failed to administered medication to R#1. LPA reviewed Mars for November and December 2022; medication was administered as prescribed by physician. Interviews conducted with staff #1 - S#8, communicated that they have never heard of any residents missing or not been given their medications. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews and records reviewed did not concur with the above allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated An exit interview was conducted with Lourdes Menchaca, Executive Director and a hard copy of report was provided.the state’s words, verbatim · CDSS document, Jul 14, 2023 · control 11-AS-20221213101417

Allegation investigated: Staff did not keep resident's authorized person informed regarding resident's care. Staff retaliated against resident for complaining. Staff did not ensure that resident's dentures were adequately installed. Staff did not ensure that resident's hearing aide was charged and properly installed.

This report supersedes report dated 05/30/23.Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Idona Avila, Family Ambassador. The investigation consisted of following: Interviews and Record reviews. On 12/19/22, LPA Montoya interviewed S#1 – Lourdes Montoya – Executive Director and toured the facility with Administrator Lourdes Menchaca. LPA requested a resident roster, staff roster and copies of one resident's (R1) service records: Admission Agreement, Physician’s Report and Appraisal, Medication Administration Records, Nurses Notes, and other pertinent records. On 05/16/23, LPA Soto conducted interviews with S#1 - Executive Director, S#2 - S#9, and R#1 - R#8. The LPA Soto also requested copies of the following documents: Partial file for R#1 (Physician's report, Physician notes, and progress notes.) Resident roster, Staff roster, MARs for (November and December 2022,) and Staff shift schedule for December 2022. Unsubstantiated Based on the LPA's investigation, the investigation revealed the following: Allegation 1 - Staff did not keep resident's authorized person informed regarding resident's care. Interviews conducted with staff #1, S#2, S#4, S#6, & S#9, communicated that R#1, family members were always at the facility. There was no way that the family members did not know what was happening with R#1, every time they would come to the facility, there were always asking about R#1 and telling staff what R#1 needed. R#1’s family members were very involved with R#1’s care. S#1 & S#2, also communicated that family members were always either calling or emailing facility about R#1’s care. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation. Allegation 2 - Staff retaliated against resident for complaining. Interviews conducted with staff #1 – S#9, communicated that they would never do anything like that to any resident for any reason and they would never allow that to happen to any resident, they would report it if they were aware of someone doing that to any resident. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation. Allegation 3 - Staff did not ensure that resident's dentures were adequately installed. Interviews conducted with staff #1, S#2, S#4, & S#9, communicated that R#1’s dentures were a bit loose, and they informed the family members. They believed they had become loose because R31 had recently lost weight. They did not fit properly. S#1 personally made sure that R31’s dentures were put in properly, cleaned and had enough paste to keep them on. S#1 asked staff to make sure they checked R#1’s dentures before every meal. The dentures would be fine but then they would move, again because they needed to be refitted and family members, never took them to get refitted for R#1. LPA reviewed admission agreement, family members were responsible for R#1’s dentures and their care. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted and records reviewed did not concur with the above allegation. Allegation 4 - Staff did not ensure that resident's hearing aid was charged and properly installed. Interviews conducted with staff #1, S#2, S#4, & S#9, communicated that R#1’s hearing aid was charged every night, but she could not hear even though, it had been charged and/or exchanged for another one. The family was responsible for providing their residents hearing aid and getting them fixed and/or replaced. The facility would let the family members know about the hearing aid and they would say that they would go and get them fixed, but the hearing aid still had the same problem. Interviews conducted with resident #1 - #8, could not communicated with LPA. LPA reviewed R\#1 admission agreement, and it was the family members responsibility to provide the hearing aids for their resident. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted and records reviewed did not concur with the above allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted with Idona Avila, Family Ambassador and a hard copy of report was provided.the state’s words, verbatim · CDSS document, Jun 23, 2023 · control 11-AS-20221214153729

Allegation investigated: Facility fire alarm system not working properly. Facility is in disrepair. Facility staff failed to administer medications as prescribed.

This report supersedes report dated 05/30/23.Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Idona Avila, Family Ambassador. The investigation consisted of following: Interviews and Record reviews. On 12/19/22, LPA Montoya interviewed S#1 – Lourdes Montoya – Executive Director and toured the facility with Administrator Lourdes Menchaca. LPA requested a resident roster, staff roster and copies of one resident's (R1) service records: Admission Agreement, Physician’s Report and Appraisal, Medication Administration Records, Nurses Notes, and other pertinent records. On 05/16/23, LPA Soto conducted interviews with S#1 - Executive Director, S#2 - S#9, and R#1 - R#8. The LPA Soto also requested copies of the following documents: Partial file for R#1 (Physician's report, Physician notes, and progress notes.) Resident roster, Staff roster, MARs for (November and December 2022,) and Staff shift schedule for December 2022. Unsubstantiated Based on the LPA's investigation, the investigation revealed the following. Allegation 1 - Facility fire alarm system not working properly. Interviews conducted with S#1, S#2, S#4, S#3, communicated that the fire alarm had been going off, but the building (beach cities) had the problem with the fire alarm. Silverado side had no issues with the fire alarm. The Silverado side could hear the alarm, but the beach cities side of the building had the issue, and they were working on resolving the fire alarm problem. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation. Allegation 2 - Facility is in disrepair. Interviews conducted with staff #1 – S#9, communicated that the facility did not have problems with the lights in the common areas. S#1, S#2, and S#4 do not recall if R#1 rooms needed light bulbs or not, they can’t remember. S#1 – S#9, also communicated that if anytime any light bulbs are needed, maintenance will replace them right away as soon as it’s reported. The facility is in great condition, maintenance is real good at fixing anything that needs repair. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation. Allegation 3 - Facility staff failed to administer medications as prescribed. Interview conducted with S#9, communicated that they spoke with R#1 family member and informed them that they had not administered R#1 medication personally, someone had given R#1 medication, but they were not sure who had administered R#1 medication, they had to look at R#1 chart to see who administered medication. RP, misunderstood S#9, that they had failed to administered medication to R#1. LPA reviewed Mars for November and December 2022; medication was administered as prescribed by physician. Interviews conducted with staff #1 - S#8, communicated that they have never heard of any residents missing or not been given their medications. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews and records reviewed did not concur with the above allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated An exit interview was conducted with Idona Avila, Family Ambassador, and a hard copy of report was provided.the state’s words, verbatim · CDSS document, Jun 23, 2023 · control 11-AS-20221213101417

Allegation investigated: Staff did not keep resident's authorized person informed regarding resident's care. Staff retaliated against resident for complaining. Staff did not ensure that resident's dentures were adequately installed. Staff did not ensure that resident's hearing aide was charged and properly installed.

Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Lourdes Menchaca, Executive Director The investigation consisted of following: Interviews and Record reviews. On 12/19/22, LPA Montoya interviewed S#1 – Lourdes Montoya – Executive Director and toured the facility with Administrator Lourdes Menchaca. LPA requested a resident roster, staff roster and copies of one resident's (R1) service records: Admission Agreement, Physician’s Report and Appraisal, Medication Administration Records, Nurses Notes, and other pertinent records. On 05/16/23, LPA Soto conducted interviews with S#1 - Executive Director, S#2 - S#9, and R#1 - R#8. The LPA Soto also requested copies of the following documents: Partial file for R#1 (Physician's report, Physician notes, and progress notes.) Resident roster, Staff roster, MARs for (November and December 2022,) and Staff shift schedule for December 2022. Unsubstantiated Based on the LPA's investigation, the investigation revealed the following: Allegation 1 - Staff did not keep resident's authorized person informed regarding resident's care. Interviews conducted with staff #1, S#2, S#4, S#6, & S#9, communicated that R#1, family members were always at the facility. There was no way that the family members did not know what was happening with R#1, every time they would come to the facility, there were always asking about R#1 and telling staff what R#1 needed. R#1’s family members were very involved with R#1’s care. S#1 & S#2, also communicated that family members were always either calling or emailing facility about R#1’s care. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation. Allegation 2 - Staff retaliated against resident for complaining. Interviews conducted with staff #1 – S#9, communicated that they would never do anything like that to any resident for any reason and they would never allow that to happen to any resident, they would report it if they were aware of someone doing that to any resident. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation. Allegation 3 - Staff did not ensure that resident's dentures were adequately installed. Interviews conducted with staff #1, S#2, S#4, & S#9, communicated that R#1’s dentures were a bit loose, and they informed the family members. They believed they had become loose because R31 had recently lost weight. They did not fit properly. S#1 personally made sure that R31’s dentures were put in properly, cleaned and had enough paste to keep them on. S#1 asked staff to make sure they checked R#1’s dentures before every meal. The dentures would be fine but then they would move, again because they needed to be refitted and family members, never took them to get refitted for R#1. LPA reviewed admission agreement, family members were responsible for R#1’s dentures and their care. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted and records reviewed did not concur with the above allegation. Allegation 4 - Staff did not ensure that resident's hearing aid was charged and properly installed. Interviews conducted with staff #1, S#2, S#4, & S#9, communicated that R#1’s hearing aid was charged every night, but she could not hear even though, it had been charged and/or exchanged for another one. The family was responsible for providing their residents hearing aid and getting them fixed and/or replaced. The facility would let the family members know about the hearing aid and they would say that they would go and get them fixed, but the hearing aid still had the same problem. Interviews conducted with resident #1 - #8, could not communicated with LPA. LPA reviewed R\#1 admission agreement, and it was the family members responsibility to provide the hearing aids for their resident. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted and records reviewed did not concur with the above allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted with Lourdes Menchaca, Executive Director and a hard copy of report was provided.the state’s words, verbatim · CDSS document, May 30, 2023 · control 11-AS-20221214153729

Allegation investigated: Facility fire alarm system not working properly. Facility is in disrepair. Facility staff failed to administer medications as prescribed.

Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Lourdes Menchaca, Administrator The investigation consisted of following: Interviews and Record reviews. On 12/19/22, LPA Montoya interviewed S#1 – Lourdes Montoya – Executive Director and toured the facility with Administrator Lourdes Menchaca. LPA requested a resident roster, staff roster and copies of one resident's (R1) service records: Admission Agreement, Physician’s Report and Appraisal, Medication Administration Records, Nurses Notes, and other pertinent records. On 05/16/23, LPA Soto conducted interviews with S#1 - Executive Director, S#2 - S#9, and R#1 - R#8. The LPA Soto also requested copies of the following documents: Partial file for R#1 (Physician's report, Physician notes, and progress notes.) Resident roster, Staff roster, MARs for (November and December 2022,) and Staff shift schedule for December 2022. Unsubstantiated Based on the LPA's investigation, the investigation revealed the following. Allegation 1 - Facility fire alarm system not working properly. Interviews conducted with S#1, S#2, S#4, S#3, communicated that the fire alarm had been going off, but the building (beach cities) had the problem with the fire alarm. Silverado side had no issues with the fire alarm. The Silverado side could hear the alarm, but the beach cities side of the building had the issue, and they were working on resolving the fire alarm problem. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation. Allegation 2 - Facility is in disrepair. Interviews conducted with staff #1 – S#9, communicated that the facility did not have problems with the lights in the common areas. S#1, S#2, and S#4 do not recall if R#1 rooms needed light bulbs or not, they can’t remember. S#1 – S#9, also communicated that if anytime any light bulbs are needed, maintenance will replace them right away as soon as it’s reported. The facility is in great condition, maintenance is real good at fixing anything that needs repair. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews conducted did not concur with the above allegation. Allegation 3 - Facility staff failed to administer medications as prescribed. Interview conducted with S#9, communicated that they spoke with R#1 family member and informed them that they had not administered R#1 medication personally, someone had given R#1 medication, but they were not sure who had administered R#1 medication, they had to look at R#1 chart to see who administered medication. RP, misunderstood S#9, that they had failed to administered medication to R#1. LPA reviewed Mars for November and December 2022; medication was administered as prescribed by physician. Interviews conducted with staff #1 - S#8, communicated that they have never heard of any residents missing or not been given their medications. Interviews conducted with resident #1 - #8, could not communicated with LPA. Interviews and records reviewed did not concur with the above allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated An exit interview was conducted with Lourdes Menchaca, Administrator, and a hard copy of report was provided.the state’s words, verbatim · CDSS document, May 30, 2023 · control 11-AS-20221213101417

Allegation investigated: Facility prohibiting resident from having visitors.

Licensing Program Analyst (LPA) Ana Soto conducted an initial complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Jessica Ponce, Director of Health Services. The investigation consisted of following: Interviews and Record reviews. On11/09/22, LPA interviewed S#1 - Jessica Ponce - Director of Health Services, S#2 - S#8, R#1 - R#7. Toured the 1st floor rooms # 113A & B, 108A, 112A, lounges, & living room. 2nd floor dining room, lounge, and office. LPA Soto received the following documents on 11/09/22: Resident Roster, Staff Schedule, Face sheet, Admissions agreement, Consent to release confidential information, POA document dated 07/11/18, Physician's Report, Pre-Appraisal, and Police report #221028082. Substantiated Based on the LPA's investigation, the investigation revealed the following. Allegation 1 – Facility prohibiting resident from having visitors. Interviews conducted with S#1, communicated that she was attempting to explain to the family member and POA for resident, that she was going to connect family member with upper management, so they could speak to family member about family members concerns. Family member yelled and screamed at S#1. S#1 repeatedly asked family member to leave, because she was causing a scene and making the residents very uncomfortable. Family member continued to yell and scream at S#1. S#1 was going to call the front desk to have them call the police, when family member lunged at S#1. S#1 backed away from family member and advised family member that type of behavior was not appropriate. Police arrived and removed family member from facility. Interviews conducted with S#2 – S#5 communicated that they did not witness the incident, but did know that family member is restricted from coming to facility. Interviews conducted with S#6 - S#8, communicated that they witnessed the incident in question and also know that family member is restricted from coming to facility. LPA reviewed SIR dated 11/04/22, were S#1 wrote that R#1 family member was not being allowed to visit or go into facility. CCLD received an email dated 10/28/22, where Silverado Beach Cities – writes to family member, they will not be allowed to enter the facility for the next couple weeks. AB 937 prohibits the facility from restricting visitors from residents. The interviews and records reviewed concur with the above allegation. Based on LPA’s observations and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation. An exit interview was conducted with Jessica Ponce, Director of Health services a hard copy of report was provided along with Appeal Rights.the state’s words, verbatim · CDSS document, Nov 9, 2022 · control 11-AS-20221102103140

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: Nov 11, 2022

To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice.....This was met as evidence by: Based on SIR & Email, restricting visits. Which poses a potential health and safety risk for all persons in care.the state’s words, verbatim · CDSS document, Nov 9, 2022

Plan of correction: Executive Director shall create a plan that insures that in the future, they don't restrict residents visitor's.

Allegation investigated: Facility staff handled resident in a rough manner Facility staff did not prevent resident's from engaging in an altercation Facility staff are not ensuring that residents are dressed appropriately Staff is insufficient to meet resident's needs

Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver amended findings and decisions for the allegations listed above, which supersedes previous report dated 10/12/21. Today’s complaint investigation was conducted with Lourdes Menchaca, Administrator. The investigation consisted of the following: Interviews and Record review. On 09/14/21, LPA Soto conducted interviews with the Jessica, LVN, S#2 - S#6. R#1 - R#7. The LPA toured rooms 104,211,301,304,307, and 309, 1st floor dining room, lounge/TV area, 2nd Floor dining room, lounge/TV area, 3rd floor dining room, lounge/TV area. LPA also requested copies of the following documents: Resident roster, Staff roster, R#1 & R#2 files (face sheet, physician's report, and pre-appraisal), S#6 file w/trainings, Staff work schedule, and training logs (transferring Dementia residents.) Unsubstantiated Based on the LPA's investigation, the investigation revealed the following. For Allegation 1 – Facility staff handled resident in a rough manner. Interviews conducted with Jessica, Director of Health Services, S#3 – S#5, they all stated that they have never witnessed any staff be rough with any resident. They conducted their own investigation and found there were no other similar incidents involving S#6. Jessica also stated that she spoke with S#6 about the incident involving him being allegiant rough with a resident and advised him that he would need to be retrain on handling Dementia resident. Interview conducted with S#2, stated that she had overheard other staff talking about S#6 being rough with resident, but could not remember who the staff were, and she never witnessed S#6 be rough with residents. Interviews with R#1, R#3, & R#5, R#6, R#7 could not understand what LPA Soto was asking and kept looking away from LPA Soto. Interviews with R#2 & R#4, stated that staff has never been rough with them or never seen any staff be rough with other residents. Interviews conducted do not concur with the above allegation. Allegation 2 - Facility staff did not prevent resident's from engaging in an altercation. Interviews conducted with Jessica, Director of Health Services, she stated that they did have 2 residents get into an altercation. She sent in the SIR. Residents fighting is very unusual, the 2 residents were separated immediately and redirected. They did not sustain any injuries. Interviews with S#2 – S#6, stated that they have never seen residents get into any altercations. Interviews with R#1, R#3, & R#5, R#6, R#7 could not understand what LPA Soto was asking and kept looking away from LPA Soto. Interviews with R#2 & R#4, stated that they have not seen residents fight. The residents R#3 & R#4 did not know or remember if they had been in an altercation. Interviews conducted do not concur with the above allegation. Allegation 3 - Facility staff are not ensuring that residents are dressed appropriately. Interviews conducted with Jessica, Director of Health Services, S#2 – S#6, stated that some of the residents have a behavior that they take their clothes and diapers off. They try to change the diaper themselves; they redirect the residents when that happens and try to let them know not to do that. They can’t remember, so they continue to do it. LPA Soto reviewed resident’s records and they show that some residents do have behaviors with taking their diaper and clothes off. The staff could not control what the residents will do, but the staff does redirect them as soon as they see the residents undressed or without diapers. Interviews with R#1, R#3, R#6, R#5, & R#7 could not understand what LPA Soto was asking and kept looking away from LPA Soto. Interviews with R#2 & R#4, stated that they have seen residents with no diapers and clothes, did not know who they were. Interviews conducted and records reviewed, do not concur with the above allegation. Allegation 4 - Staff is insufficient to meet resident's needs. Interviews conducted with Jessica, Director of Health Services, she stated that they have enough staff to cover all shifts. They are trying to see if more staff is needed, but they are not definite on them hiring extra staff. LPA Soto reviewed staff schedule and it showed that the facility does have enough staff for all shifts. Interviews with R#1, R3, R#5, R#6, & R#7, could not understand what LPA Soto was asking and kept looking away from LPA Soto. Interviews S#2 – S#6 and R#2 & R#4, they stated that they feel and/or believe there are enough staff to take care of the resident’s needs. Interviews conducted and records reviewed, do not concur with the above allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated An exit interview was conducted with Lourdes Menchaca, Administrator and a hard copy of report was provided.the state’s words, verbatim · CDSS document, Mar 18, 2022 · control 11-AS-20210909113121

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required visit and an infection control inspection to the above facility. LPA was met by receptionist (Julia Vega) and later met with Lourdes Menchaca, Administrator and the purpose of today’s visit was explained. There are currently (60) residents in the facility. (0) residents are ambulatory and (60) are non-ambulatory. The facility is a (4) four story structure located on a commercial building in a residential neighborhood. The facility is in east side of the commercial building. It consists (110) bedrooms, (71) bathrooms, 1st floor, 2nd floor, 3rd floor, and 4th floor are mirror image of themselves. all the floors contain lounge / movie room, kitchenette, clean linen rooms, mechanical rooms, activities/dining room. activities storage room, Well-ness room, nursing supplies, laundry shoot room. 1st floor has a fireplace in lounge room, shaded side yard with gazebo, plants, and play area, 2nd floor has an incontinence room/staff lounge, and 4th floor has PT/gym room. The basement has (kitchen, laundry room, and PPE storage.) LPA and Administrator toured the entire facility inside and out. Documents are posted as mandated. Most bedrooms are occupied by residents and contain the mandated furniture. All bathrooms are clean and operational. First aid kit completes with manual; smoke detectors and carbon monoxide detector are connect with fire department, system was in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. 3 staff files are complete and current. 3 residents files with medication are complete and current. Ample supply of perishable and nonperishable food, hot water temperature is 113.2 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 17 fire extinguishers are fully charged. Exit, walkways and/or passageways, side yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged, and temperature checked, sanitizer/soap in all bathroom with paper towels and additional sanitation supplies are locked in storage rooms on each floor. LPA observed staff and clients wearing masks, residents’ private rooms will be converted to isolation rooms (if needed) and required postings throughout the facility. The facility has an approved Mitigation plan. The resident’s temperatures are checked and logged once a day. PPE's are enough for 30 days. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. An exit interview conducted with Lourdes Menchaca, Administrator and a hard copy of report provided.the state’s words, verbatim · CDSS document, Mar 18, 2022

Allegation investigated: Facility staff refrained resident from activity.

On 12/21/2021 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Administrator Lourdes Menchaca and Health Services Director Jessica Ponce. The investigation consisted of the following: LPA Senaha requested and received resident roster, staff roster and other service documents on 12/21/2021. LPA Senaha interviewed residents (R1-R9) and staff (S1-S7). A plant inspection of the facility was conducted. Investigation revealed: Unsubstantiated Allegation: Facility staff refrained resident from activity. It is alleged that the facility staff refrained resident from activity. Residents (R4-R9) did not have any concerns regarding the care and supervision being provided to them by the staff. Residents (R1-R3) were non-verbal. LPA observed residents (R1-R3) in dining area for lunch. Residents (R4–R9) stated they have never been told they cannot leave the facility with a family member. Residents (R4-R9) stated they are offered and encouraged to participate in activities every day. Residents (R4-R9) stated they have never been told they cannot participate in an activity offered by the facility. Staff (S1-S7) stated family members can take a family member out of the facility as long as the family member follows the facility protocols. Staff (S1-S7) stated they make sure they get all the residents out of bed each day. Majority of the staff stated they get the residents out of bed for breakfast, shower or change in the morning. Staff (S1-S7) stated there is an activity coordinator and the residents are encouraged to participate in activities each day. Majority of the staff stated the residents exercise or residents that are non-ambulatory are scheduled for sensory activities such as sound, taste, feel, massage and range of motion to keep the body moving and blood flowing. Majority of the staff stated they do take residents out in the afternoon whether permitting to get some fresh air. LPA obtained monthly activities calendar showing the activities by the hour each day. LPA observed activities calendar posted on each floor. LPA observed activities calendar at the front desk/lobby area for visitors to take. Based on LPA’s observation, interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated. There were no deficiencies found at the time of the visit. An exit interview was conducted with Administrator Lourdes Menchaca, and a hard copy was provided.the state’s words, verbatim · CDSS document, Dec 21, 2021 · control 11-AS-20211214153013

Allegation investigated: Facility does not allow resident to choose preferred services Facility does not assist resident with obtaining medical care

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Monday, December 20, 2021. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met with Administrator Lourdes Menchaca and Jessica Ponce. LPA Bunker explained the purpose of today's visit. The investigation consisted of the following: LPA Bunker interviewed staff 1-3 (S1-3) and attempted to interview residents 2-7 (R2-7), all residents interviewed had some form of memory loss and had difficulty answering the questions. LPA Bunker asked questions relevant to the nature of the complaint. LPA Bunker requested and reviewed resident 1's (R1) records. Administrator Lourdes Menchaca and Director of Health Services, Jessica Ponce, LVN, stated resident's daughter doesn't want to follow Silverado's medication policy. Staff stated Silverado makes every effort to keep its residents safe and provide quality medical care to all residents. Staff states they reported the special incident report regarding R1 in a timely manner. See continued LIC9099-C page 2 Unsubstantiated Continued LIC9099-C page 2 LPA Bunker requested copies of the following documents: Admission Agreement, Medication Log, Medical Administration Records (MARs), Personal Rights, Identification and Emergency Information, Consent for Emergency Medical Treatment, Replacement Appraisal Information, Physician Orders, Physician's Report for Residential Care for the Elderly (RCFE), Resident Pharmacy Enrollment Form, COVID-19 Vaccination Record Card, Silverado Pharmacy Policy, and Resident Roster Allegation #1 Facility does not allow a resident to choose preferred services. Staff 1-3 (S1-3) interviewed stated the facility does allow residents to choose their preferred services, the facility requires thirty (30) day supplies of medication. R1 received a new order for medication, staff requested the medication and the daughter said she was busy and would bring it in the next day after multi attempts. The daughter brought in two (2) of R1 medication, Tylenol (10 days late) and tramadol for pain (2 days late), the facility is requesting bubble packs. It helps ensure accuracy and safety for residents. Staff stated uniform packaging of medications allows the nurses to easily be accountable for the large numbers of medications that their residents take. Staff stated R1 can use her own pharmacy, the facility must have the medications in a timely manner. The daughter is using CVS Pharmacy and the facility uses Omnicare Pharmacy and suggested it to the daughter and she stated she prefers CVS because she knows the Pharmacist and likes to visit with him. Staff stated they informed the daughter the facility is responsible if there is a medication error that's why it is important to have the new prescription order filled immediately. Staff stated Silverado Senior Living makes every effort to keep its residents safe and provide quality of care to all residents. As part of their resident safety program, Silverado Senior Living follows a pharmacy policy that requires that all residents obtain their medications through an approved pharmacy that contracts with Silverado and packages all medications in a uniform system. Staff stated they are following Title 22 Regulations regarding medication. See continued LIC9099-C page 3 Continued LIC9099-C page 3 Allegation #2 Facility does not assist a resident with obtaining medical care. Staff 1-3 (S1-3) interviewed stated the facility does assist R1 with medical care. Staff stated Silverado Senior Living makes every effort to keep its residents safe and provide quality of medical care to all residents. R1 daughter suggests staff use force when they are performing a range of motion therapy on R1 arms. Staff stated this is not a skilled nursing facility. They do not perform physical therapy at Silverado Senior Living-Beach Cities. The facility staff doesn't want to cause R1 any pain or injury and is following R1 physician's orders. Staff stated R1 may need a higher level of care. LPA Bunker observed the special incident report dated 12/17/2021 regarding R1 arms that were self-reported by the facility staff in a timely manner. Staff stated they are providing R1 with the necessary care and supervision. According to Title 22 Regulations. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. A copy of the Complaint Investigation Report LIC 9099, LIC9099-Cs, and Confidential Names LIC 811 was provided to Administrator Lourdes Menchaca There were no deficiencies cited. Exit interview conductedthe state’s words, verbatim · CDSS document, Dec 20, 2021 · control 11-AS-20211214170629

Allegation investigated: Facility staff handled resident in a rough manner Facility staff did not prevent resident's from engaging in an altercation Facility staff are not ensuring that residents are dressed appropriately Staff is insufficient to meet resident's needs

Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Jessica Ponce, Director of Health Services. The investigation consisted of the following: Interviews and Record review. On 09/14/21, LPA Soto conducted interviews with the Jessica, LVN, S#2 - S#6. R#1 - R#6. The LPA toured rooms 104,211,301,304,307, and 309, 1st floor dining room, lounge/TV area, 2nd Floor dining room, lounge/TV area, 3rd floor dining room, lounge/TV area. LPA also requested copies of the following documents: Resident roster, Staff roster, R#1 & R#2 files (face sheet, physician's report, and pre-appraisal), S#6 file w/trainings, Staff work schedule, and training logs (transferring Dementia residents.) Based on the LPA's investigation, the investigation revealed the following. For Allegation 1 – Facility staff handled resident in a rough manner. Interviews conducted with Jessica, Director of Health Services, S#3 – S#5, they all stated that they have never witnessed any staff be rough with any resident. They conducted their own investigation and found there were no other similar incidents involving S#6. Jessica also stated that she spoke with S#6 about the incident involving him being allegiantly rough with a resident and advised him that he would need to be retrain on handling Dementia resident. Interview conducted with S#2, stated that she had overheard other staff talking about S#6 being rough with resident, but could not remember who the staff were, and she never witnessed S#6 be rough with residents. Unsubstantiated Interviews with R#1, R#3, & R#5, could not understand what LPA Soto was asking and kept looking away from LPA Soto. Interviews with R#2 & R#4, stated that staff has never been rough with them or never seen any staff be rough with other residents. Interviews conducted do not concur with the above allegation. Allegation 2 - Facility staff did not prevent resident's from engaging in an altercation. Interviews conducted with Jessica, Director of Health Services, she stated that they did have 2 residents get into an altercation. She sent in the SIR. Residents fighting is very unusual, the 2 residents were separated immediately and redirected. They did not sustain any injuries. Interviews with S#2 – S#6, stated that they have never seen residents get into any altercations. Interviews with R#1, R#3, & R#5, could not understand what LPA Soto was asking and kept looking away from LPA Soto. Interviews with R#2 & R#4, stated that they have not seen residents fight. Interviews conducted do not concur with the above allegation. Allegation 3 - Facility staff are not ensuring that residents are dressed appropriately. Interviews conducted with Jessica, Director of Health Services, S#2 – S#6, stated that some of the residents have a behavior that they take their clothes and diapers off. They try to change the diaper themselves; they redirect the residents when that happens and try to let them know not to do that. They can’t remember, so they continue to do it. LPA Soto reviewed resident’s records and they show that some residents do have behaviors with taking their diaper and clothes off. The staff could not control what the residents will do, but the staff does redirected them as soon as they see the residents undressed or without diapers. Interviews with R#1, R#3, & R#5, could not understand what LPA Soto was asking and kept looking away from LPA Soto. Interviews with R#2 & R#4, stated that they have seen residents with no diapers and clothes, did not know who they were. Interviews conducted and records reviewed, do not concur with the above allegation. Allegation 4 - Staff is insufficient to meet resident's needs. Interviews conducted with Jessica, Director of Health Services, she stated that they have enough staff to cover all shifts. They are trying to see if more staff is needed, but they are not definite on them hiring extra staff. LPA Soto reviewed records and the facility does have enough staff for all shifts. Interviews with S#2 – S#6 and R#1 – R#6, They all stated that they feel and/or believe there are enough staff to take care of the resident’s needs. Interviews conducted and records reviewed, do not concur with the above allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated An exit interview was conducted with Jessica Ponce, Health Services Director, and a hard copy was provided.the state’s words, verbatim · CDSS document, Oct 12, 2021 · control 11-AS-20210909113121

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Ana Soto, conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation. Due to the situation surrounding the Corona virus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted a tele-visit with Daizel Gasperian, the facility administrator. An application was submitted to Community Care Licensing Department (CCLD) on 08/19/2019 for an initial license for Residential Care For Elderly 60 years and above. The requested capacity is for (120) Residents,(0) ambulatory and (120) non-ambulatory. Structure: Facility is in a office building with other business offices. The facility has 4 floors, 60 rooms, and 1 elevator. The suite is on the First floor it has a lobby, receptionist counter, administrators office, sales office, and file room on one side of the first floor. They have the required Covid-19 posting on the front door of the Suite, along with the sign-in log sheet and sanitary station. Across the hall from the suite, they have the residents rooms. The resident section is on the 1st Floor. They have a common area (TV, Piano, 4 chairs, computer area) dining room, patio has( 2 tables, 2 umbrellas, and 2/3 chairs, and game tables.) Next to the dining area there's a kitchenette for staff. The wellness room is located right in middle of the floor, for all 4 floors. The 2nd, 3rd, and 4th floors are the same the design as the first floor. Signal System: Signal system in facility. Bedroom Residents: There shall be no more than two clients per bedrooms. bedrooms are designated resident bedrooms properly equipped with regulation guidelines of two beds, two chairs, two night stands, two lamps and overhead lighting. Presently, 120 bedrooms are occupied by 2 clients and 1 bedroom by 1 client. Bedroom Staff: No bedrooms will be used for awake staff. Bathrooms: 64 bathroom, 60 located in each room of the 4 floors of the facility: have working toilets and wash basin, a walk-in shower with folding bench, grab bars, and mats. 4 other bathrooms are visitor bathrooms, located 1 in every floor. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen is stored in basement where the house keeping supplies are kept. Emergency Phone Numbers, Exit Plan, & Menu: Emergency numbers and menu are posted and readily available for review in suite lobby. Facility has a land line telephone located in the suite lobby. 1 Fire extinguisher, in the kitchen area which is labeled, they are tagged with current annual checks. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in locked storage drawers in the kitchen cabinets. Adequate food supply is stored in kitchen, and consists of the following: 2 day perishables, and 7 week non-perishables. Smoke Detectors: There are 60 hard wired smoke detectors, sprinkler system in all the facility which are inter connected. Carbon monoxide detector near the sprinkler system by room 101. Appliances: Stove burners, oven, microwave, freezers and washers/dryers are in working condition. The residence is equipped with central heat and air conditioning. There are 10 thermostat's for each floor to regulate the temperature in the residents rooms. Toxins: Cleaning supplies, and toxins are stored in the laundry room in the basement. Water Temperature: Water was tested in bathrooms and kitchen sink within 105-120 degrees Fahrenheit range. Medication, First-Aid Kit & Book: Designated area for centrally stored medication is located the 1st floor wellness room. A first-aid kit has been inspected which has at least the following: thermometer, tweezers ,scissors, antiseptic, bandages, gauze and current first aid manual, which are stored with medication in the wellness room, available for staff use but inaccessible to clients. Clients & Staff Files: Designated area for files will be located in the 1st floor suite next to administrators office. Pools/Jacuzzi & Pets: No bodies of water and no pets on these premises. . Fire Clearance: Fire clearance does not indicate any delayed egress or any locked perimeter. Component III and LPA also explained ROM 20-28 at the time of the Pre-Licensing. There are no corrections to be made. A tele-visit exit interview was conducted and a copy of this report has been furnished to the applicant via email for signature. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.the state’s words, verbatim · CDSS document, Mar 4, 2021