Silverado Senior Living - Belmont Hills

Type of visit: Case Management - Other

On September 29, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit. LPA met with Administrator, Robert Snee, Director of Health of Services, Amyda Astrero and Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. The purpose of today's visit is to deliver an immediate exclusion letter to exclude an employee of the facility. The letter was given to the Administrator. This report is reviewed and discussed with the Licensee and a copy is provided.the state’s words, verbatim · CDSS document, Sep 29, 2023

Type of visit: Case Management - Incident

On September 7, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit at the facility to follow up on an incident that was reported on 8/28/2023. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero and explained the purpose of the visit. The Licensee reported on 8/25/2023, Staff #1 (S1) reported to Administrator that he/she observed Staff 2 (S2) throw a cup of tea on Resident 1 (R1). In addition, S1 reported that he/she observed S2 on 7/25/2023 make contact with S2's hand to Resident 3 (R3). During the visit, LPA discussed incidents with the administrator and director of health services. According to the interviewed staff, there were not witnesses for the two incidents being reported by S1. S2 was immediately suspended on 8/25/2023 and later terminated on 8/30/2023. Belmont Police, Ombudsman and all required parties were notified. Administrator to send facility's internal investigation records to LPA by 9/8/2023. No deficiencies are cited during visit. LPA to conduct a follow up visit if required. Report is reviewed with Director of Health Services and a copy is provided.the state’s words, verbatim · CDSS document, Sep 7, 2023

Type of visit: Case Management - Incident

On August 18, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit to follow up on an incident that was reported to CCLD on 8/17/2023. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero and explained the purpose of the visit. The Licensee reported on 8/10/2023, Resident 1 (R1) was bitten by a dog. Blood was noted on right middle finger, however R1 denied pain. During the visit, LPA interviewed the administrator, requested copies of the dog's vaccination records, reviewed facility policies and procedures regarding pets, observed blank facility admission agreement and reviewed a copy of resident handbook regarding pets at the facility. According to the administrator and director of health services, there were no prior biting incidents at the facility with this specific dog. The dog was returned back to the adoption center after the incident. LPA reviewed resident handbook and policies and procedures regarding pets at the community. Based on the resident handbook reviewed, it indicated that the community has pets to promote resident's quality of life. In addition, the facility handbook also indicates that residents are welcome to bring their pets as well. Furthermore, LPA reviewed the dog's vaccination record and all shots are up to date. No deficiencies cited during the visit. Report is reviewed with Director of Health Services and Administrator and a copy is provided.the state’s words, verbatim · CDSS document, Aug 18, 2023

Type of visit: Case Management - Incident

On August 2, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that was reported to CCL on 7/20/2023. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero and explained the purpose of the visit. The Licensee reporting on 7/18/2023, a staff member (S1) reported 3 separate incidents that occurred between Staff 2 (S2) and 3 different residents. During the visit, LPA collected documentation. No citations are issued at this time. Report is reviewed with administrator and a copy is provided.the state’s words, verbatim · CDSS document, Aug 2, 2023

Type of visit: Case Management - Incident

On May 3, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that occurred on April 22, 2023. LPA met with Administrator, Robert Snee, Director of Health Services, Amyda Astrero and Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. On May 1, 2023, the Licensee reported that a caregiver heard R1 shouting for help while being in the Maple dining room. According to the Licensee, the caregiver found R2 sitting on R1 with one hand on R1's chest and the other hand between R1's legs. During the visit, LPA discussed the incident with Administrator, Director of Health Services, and Assistant Directors of Health Services and reviewed resident files. According to the Administrator, this incident occurred after dinner when caregivers were assisting put residents to bed. The Director of Health Services indicated that the caregiver immediately responded to R1 as his/her room is near the Maple dining room. Based on R1 and R2's file, both residents have a diagnosis of dementia. According to the Director of Health Services and file reviewed, R2 does not have a history of touching residents, however he/she does have a wandering behavior where he/she wanders in the hallways or other residents rooms. During the visit today, LPA observed a one on one caregiver with R2. In addition, R2's medication dosage was increased. Furthermore, Administrator indicated that R2's room was changed to the Cedar building. No citations issued during this time. Report is reviewed with Robert Snee, Amyda Astrero, and Hazel Yabut and a copy is provided.the state’s words, verbatim · CDSS document, May 3, 2023

Type of visit: Case Management - Other

On March 17, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management. LPA met with Administrator, Robert Snee and explained the purpose of the visit. The Department is amending the licensing report dated April 29, 2022 for complaint control number 14-AS-20220216135656 as per the February 24, 2023 First Level Appeal Response and reissuing the Reporting Requirements citations for Section 87211(a)(1) and Section 87211(b) as one violation. Deficiency of the Residential Care Elderly California Code of Regulations, Title 22, Division 6 is observed and cited on a LIC 809D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with Administrator and a copy is provided with appeals rights.the state’s words, verbatim · CDSS document, Mar 17, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(b) · Plan of correction due date: Mar 24, 2023

87211: Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below…(b) “Any suspected physical abuse that results in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within two (2) hours as required by Welfare and Institutions Code Section 15630(b)(1)”. Violation of this regulation is evidenced by: The facility failed to provide the LIC624 and SOC341 to the Department within regulatory timeframes for the incident of alleged abuse that occurred on February 13, 2022.the state’s words, verbatim · CDSS document, Mar 17, 2023

Plan of correction: On 5/4/22, facility submitted acknowledgement of Title 22 regulations for reporting requirements 87211. POC was cleared on 5/6/22 by LPA

Type of visit: Case Management - Other

On February 3, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced visit and met with the Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. The purpose of today's visit is to deliver an immediate exclusion letter to exclude an employee of the facility. The letter was given to the Assistant Director of Health Services. This report is reviewed and discussed with Assistant Director of Health Services. A copy is provided.the state’s words, verbatim · CDSS document, Feb 3, 2023

Type of visit: Required - 1 Year

On January 27, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual infection control inspection. LPA observed the COVID-19 signage posted on the door of the front lobby. LPA was screened at entry point and observed the visitor screening log documentation. LPA met with Director of Health Services (DHS), Amyda Astrero and Administrator, Robert Snee joined shortly thereafter. Administrator was able to provide screening log documentation for staff and residents to LPA. This facility is a locked memory care facility and the central entry point is the front lobby. LPA toured the facility and grounds. No accessible bodies of water or fire safety hazards observed. The facility has a total of four different buildings (Twin Pine, Oak, Bay, Cedar/Maple) for residents based on the level of care required. LPA toured the facility with Administrator and DHS and observed the library room. 30-day PPE supply was located in a closet in the library. All communal bathrooms throughout the facility was observed to be equipped with liquid soap, paper-towels, hand washing signs, and a trash can with a fitted lid. LPA toured all four buildings at the facility and observed it to be clean, odorless and free from any tripping hazards. A comfortable temperature of 70-73 degrees F is maintained and lighting is sufficient for comfort. There are a total of four dining rooms at the facility for residents; no toxins, chemicals, or sharps were observed present. LPA observed resident activities calendar posted in the hallways of the resident buildings. LPA observed two Wellness Centers located at the facility. Wellness Centers had medication locked and stored appropriately and inaccessible to residents. LPA observed the first aid kits in the wellness center to be present and completed. COVID signage was observed to be posted throughout the facility. During the visit, LPA observed staff wearing face masks. LPA observed 4 locked laundry rooms. Toxins and chemicals were observed to be locked and inaccessible to residents. LPA observed additional toxins and chemicals locked outside in the housekeeping storage room. LPA toured and observed the kitchen to be clean and observed 2 day perishable and 7 day non-perishable. There is a locked gate separating the kitchen and the housekeeping storage room from resident buildings. Infection control practices are observed: COVID signage posted throughout the facility, entry procedures, daily monitoring log for staff, residents and visitors, 30-day PPE supply, face coverings for staff, containment strategies, staff training and policies. No citations issued during the visit. Report is reviewed with Director of Health Services and a copy is provided.the state’s words, verbatim · CDSS document, Jan 27, 2023

Type of visit: Case Management - Incident

On October 17, 2022, Licensing Program Analyst (LPA) Komal Charitra and Licensing Program Manager (LPM) Cara Smith conducted an unannounced case management visit to follow up on a visit made on October 10, 2022. LPA and LPM met with Director of Health Services (DHS), Amyda Astrero and Administrator, Robert Snee, joined shortly thereafter. LPA explained the purpose of the visit. On October 10, 2022, LPA conducted a case management visit to follow up on an un-witnessed incident that occurred on September 25, 2022 where Resident #2 (R2) was screaming and agitated and verbalized Resident #1 (R1) touched R2's breast and shook it. During the visit, LPA Charitra and LPM Smith toured the facility with DHS, Amyda Astrero and observed R1 sleeping in bed with his/her one on one caregiver in the room. LPA and LPM reviewed R1's file and needs and service plan. In addition, LPA Charitra and LPM Smith interviewed DHS and Administrator regarding R1. According to the Administrator and DHS, R1 has a new Geriatric doctor that has been in communication with the facility. In addition, it was indicated that R1 is on new medications prescribed by the new doctor. According to the file reviewed, R1 was admitted to the facility on May 3, 2022 and this incident is his/her fifth incident at the facility, three of which are of R1 displaying inappropriate behaviors towards female residents. In addition, based on R1's needs and service plan, R1 has a history and pattern of aggressive and inappropriate behaviors towards residents. Although facility has interventions in place, R1 has re-occurring incidents. Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. Report is reviewed with Director of Health Services (DHS), Amyda Astrero and Administrator, Robert Snee, and a copy is provided with appeals rights.the state’s words, verbatim · CDSS document, Oct 17, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Oct 18, 2022

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment Violation of this regulation is not met as evidenced by: Based on the interviews conducted and the file reviewed, R1 has a history of aggressive and inappropirate behaviors towards other residents in care. Furthermore, due to R1's inappropriate behaviors, the facility environment is not comfortable for other residents in care.the state’s words, verbatim · CDSS document, Oct 17, 2022

Plan of correction: In-service training with staff members in relation to reporting inappropriate behaviors. Facility will communicate with resident's physician regarding the behaviors being displayed

Type of visit: Case Management - Incident

On October 10, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that was reported to CCLD on October 3, 2022. LPA met with Director of Health Services, Amyda Astrero and Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. The Licensee reported on September 25, 2022, Resident #1 (R1) and Resident #2 (R2) were found in R2's room. It was indicated R2 was agitated and screaming because R1 touched him/her. According to the Director of Health Services, R1 did not have a one on one caregiver assigned at this time. During the visit, LPA reviewed R1's file and interviewed staff. According to the file reviewed, R1 has a diagnosis of dementia. In addition, R1 has had a prior incident where R1 was found naked in another resident's bed. According to the interviewed staff, R1 has a new Geriatric doctor in which the facility has been in communication with daily, and R1's medications have been adjusted. In addition, Director of Health Services and Assistant Director of Health Services, indicated R1 has an one on one caregiver assigned around the clock and has notified all required parties. The facility had a care team meeting to discuss R1's behaviors and future care plans and has been in touch with R1's responsible party on a daily basis. No citations issued during the visit. LPA reviewed report with Director of Health Services, Amyda Astrero and Assistant Director of Health Services, Hazel Yabut and a copy is provided.the state’s words, verbatim · CDSS document, Oct 10, 2022

Type of visit: Case Management - Incident

On September 23, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on incidents that were reported to CCLD. LPA met with Director of Health Services, Amyda Astrero and Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. The Licensee reported on 9/7/22, Resident #1 (R1) and Resident #2 (R2) were heard yelling. Staff separated the resident and spoke to the residents. According to R1, he/she was hit on the left side of the chest by R2 and according to R2, R1 hit him/her on the arm. During the visit, LPA observed residents files and observed the residents. R1 was observed to be sleeping and R2 was observed to be eating lunch. Based on file reviewed, R1 and R2 has a diagnosis of Dementia. In addition, LPA reviewed R1's and R2's service plan and it indicated that facility is conducting behavior mapping and are keeping both residents apart from each other. The Licensee reported on 9/9/22, Resident #3 (R3's) one on one caregiver reported that R3 hit R2. According to the Licensee, it was indicated that the R3 said something to R2, however R2 did not acknowledge resulting to R3 throwing juice on R2 and punching him/her on the left side of the chest. According to the Director of Health Services, R3's one on one caregiver was also punched by R3. During the visit, LPA observed R3 having lunch and observed a male one on one caregiver present. Based on file reviewed, R3 has a diagnosis of dementia and has been assigned a one on one caregiver since admission based on physician and responsible party due to agitation and wandering behavior. LPA reviewed the needs and service plan for R3 and it indicates that physician adjusted his/her medication and behavior mapping is being conducted. In addition, the facility will ensure that there is a male one on one caregiver assigned to R3 at all times. On 9/11/22, the Licensee reported an unwitnessed incident that Resident #4 (R4) was pulling down his/her pants to urinate. Resident #5 (R5) yelled at R4 resulting to R4 becoming agitated and slapping R5 in the face. During the visit, LPA observed both residents to be eating lunch. Based on file reviewed, both residents have a diagnosis of dementia. According to the Director of Health Services, R4 had a medication adjustment and a urine analysis was done. Behavior mapping is being conducted for both R4 and R5. Report is reviewed with Director of Health Services and Assistant Director of Health Services and a copy is provided. No citations issued during the visit.the state’s words, verbatim · CDSS document, Sep 23, 2022

Type of visit: Case Management - Incident

On September 12, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that was reported to CCLD on September 9, 2022. LPA met with Assistant Director of Health Services, Hazel Yabut and Administrator, Robert Snee. Director of Health Services, Amyda Astrero joined shortly thereafter. LPA explained the purpose of the visit. The Licensee reported on September 7, 2022, Resident #1 (R1) was observed to have jumped over the facility fence near the activity office using a planter. Staff assisted R1 up, however R1 attempted to run after his wife who had just visited. Staff redirected R1 back to the facility. No injuries were noted. During the visit, LPA observed R1 walking outside with his assigned one on one caregiver. LPA reviewed R1's files and interviewed staff. File reviewed indicates that R1 is a newly admitted resident that has a diagnosis of Parkinson's Dementia and is unable to leave the facility unassisted. According to the Director of Health Services, Amyda Astrero and Assistant Director of Health Services, the facility notified R1's responsible party and R1's physician as required. R1's physician adjusted R1's medications and a one on one caregiver was assigned. Behavior mapping is still being conducted on resident. No citations were issued during today's visit. LPA reviewed report with Director of Health Services and Assistant Director or Health Services and a copy is provided.the state’s words, verbatim · CDSS document, Sep 12, 2022

Type of visit: Case Management - Incident

On July 19, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that was reported to CCLD. LPA met with Interim Administrator, Robert Snee and Director of Resident and Family Services, Kate Rickard and explained the purpose of the visit. The Licensee reported on July 15, 2022, Resident #1 (R1) was observed by a caregiver laying besides Resident #2 (R2), who was fully clothed and sleeping during the time. Caregiver immediately redirected R1 and called for additional help. During the case management visit, LPA observed R1 eating lunch in the dining room with his/her private caregiver. In addition, during the visit, LPA interviewed staff and reviewed R1's file. According to R1's file reviewed, R1 has a diagnosis of dementia. Interviewed staff indicated that a private caregiver was assigned to R1, and R1 will have a full work up conducted on 7/20/22 by R1's primary care physician. It was also indicated that R1's medications will be adjusted. This is the second unusual behavior involving R1, as the other incident occurred on 5/26/22, where R1 was found in a female resident's room. (see LIC809 dated 6/16/2022). Due to staff's lack of supervision, R1 a dementia resident, was able to walk into R2's room and lay besides him/her. Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. Report is reviewed with Interim Administrator, Robert Snee and a copy is provided with the appeals rights.the state’s words, verbatim · CDSS document, Jul 19, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jul 26, 2022

87464(f)(1) Basic Services(f)- Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). Violation of this regulation is not met as evidenced by: Based on the file reviewed and interviews conducted, R1 has a diagnosis of dementia. In addition, staff were aware of R1's prior history of unusual behavior that occurred on 5/26/22 but failed to ensure another unusual incident involving R1 will occur.the state’s words, verbatim · CDSS document, Jul 19, 2022

Plan of correction: Facility will continue to consult responsible party and physicians regarding medication adjustment and changes in condition. Facility assigned R1 a private caregiver. Facility contacted physician for medication adjustment. A full work up will be conducted by R1's phsycian on 7/20/22.

Type of visit: Case Management - Incident

On July 18, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that occurred on July 11, 2022. LPA met with Staffing Coordinator, Maria Miller and Director or Resident and Family Services, Kate Rickard joined shortly thereafter. LPA explained the purpose of the visit. The Licensee reported on July 11, 2022, Resident #1 (R1) was observed by a caregiver (S1) climbing over the facility gate. S1 immediately ran towards R1 and called for help. R1 was already on the other side of the gate by the time S1 got to the gate. R1 was observed outside the community, walking up the hill to the twin pine park. Staff members followed R1 and tried redirecting him/her to the facility, however R1 refused. Medications were administered to R1 and R1 became cooperative and returned back to the community. During the visit, LPA reviewed R1's files and interviewed staff. Files reviewed indicated that R1 has a diagnosis of Alzheimer's Dementia and is unable to leave the facility unassisted. According to the staff interviewed, R1 is a newly admitted resident and has a history of elopement from previous facility. According to R1's file, R1 eloped from a facility by climbing a 10ft wall. The facility notified responsible party and R1's physician. R1's physician adjusted R1's medications and a one on one caregiver was assigned. Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. Report is reviewed with Staffing Coordinator, Maria Miller and Director or Resident and Family Services, Kate Rickard and a copy is provided with appeals rights.the state’s words, verbatim · CDSS document, Jul 18, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jul 25, 2022

87464(f)(1) Basic Services(f)- Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). Violation of this regulation is not met as evidenced by: Based on interviews conducted and file reviewed, although R1 is a newly admitted resident, R1 has a history of elopement from his/her previous facility by climbing a wall. In addition, file reviewed indicated R1 has a diagnosis of Alzheimer's dementia and is unable to leave the facility unassisted.the state’s words, verbatim · CDSS document, Jul 18, 2022

Plan of correction: Facility will conduct a drill regarding elopmenet. The facility will conduct in-service training regarding the importance of resident history and using it to implement a proper care plan

Type of visit: Case Management - Incident

On July 5, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that was reported to CCLD on June 24, 2022. LPA met with Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. The licensee reported on June 19, 2022, Staff #1 (S1) indicated that Resident #1 (R1) may have eaten cat food. Staff found empty food bowls for cats in R1's room. According to the facility, there were no signs and symptoms of pain notes. During the visit, LPA reviewed R1's file and spoke to the assistant director of health services. According to the file reviewed, R1 has a diagnosis of dementia. According to the staff interviewed, there were no witnesses during the time of the incident so the facility is unaware whether resident ate the cat food. In addition, interviewed staff indicated that when staff went into R1's room, R1 had food bowls stacked in his/her room. R1 would not say if he/she ate the cat food or not. According to the Assistant Director of Health Services, the facility moved R1 to another neighborhood due to R1 needing higher level of care. Facility also removed all cat food bowls so it is not visible to other residents. Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. Report is reviewed with Assistant Director of Health Services, Hazel Yabut and a copy is provided with appeals rights.the state’s words, verbatim · CDSS document, Jul 5, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jul 12, 2022

87464(f)(1) Basic Services(f)- Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). Violation of this regulation is not met as evidenced by: Based on the file reviewed and interview conducted, the facility did not ensure basic services were being met, due to lack of supervision, R1 possibly eating cat food. In addition, there were no witenesses during the time of the incident so facility is unaware if R1 ate cat food which poses a potential health, safety and personal rights risk to residents.the state’s words, verbatim · CDSS document, Jul 5, 2022

Plan of correction: The Executive Director and/or designee will provide caregiver training regarding supervision to prevent this from happening again and will submit a copy of the lesson plan and the sign-in sheet to CCL by 7/12/22.

Type of visit: Case Management - Incident

On June 16, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on incidents that were reported to CCLD. LPA met with Assistant Director of Health Services, Hazel Yabut, and explained the purpose of the visit. The Licensee reported that resident (R1) had three separate incidents; one on 5/27/22 and two on May 30, 2022. On 5/27/22, it was reported that R1 hit an agency caregiver (S1) in the face, causing both R1 and S1 to fall to the floor. In addition, it was indicated that during this incident, a second caregiver (S2) present was knocked to the floor after attempting to redirect R1. On May 30, 2022, it was reported that R1 touched a caregiver (S3) while giving R1 a shower in the morning. Later in the day, it was reported that R1 touched another resident (R2). During the case management, LPA interviewed staff and reviewed R1's file. According to the file reviewed and the interviews conducted, R1 is a newly admitted resident with a diagnosis of Dementia with behavioral disturbances. In addition, LPA reviewed R1's service plan and it indicates that R1's medications were adjusted, facility implemented frequent checks and has assigned R1 with two caregivers to be present when providing care. On 5/26/22, the licensee reported a male resident (R3) walked into a female resident's room (R2); no injuries were reported. During the visit, LPA observed the residents and reviewed R3's file and interviewed staff. According to file reviewed, R3 has a diagnosis of dementia. Interviewed staff indicated that R3 does not have any prior history of unusual behavior. Based on R3's needs and services, the facility implemented frequent checks to prevent this incident from happening again. LPA reviewed this report with the Assistant Director of Health Services, Hazel Yabut; a copy is providedthe state’s words, verbatim · CDSS document, Jun 16, 2022

Type of visit: Case Management - Incident

On May 24, 2022, Licensing Program Analyst (LPA) conducted an unannounced case management visit. LPA met with interim Administrator, Robert Snee, and Director of Health Services, Glynis Marcantel joined shortly thereafter. LPA explained the purpose of the visit. The licensee reported on May 13, 2022, Resident (R1) was observed by the front receptionist to be walking toward the main office. According to R1, it was indicated at first that he/she jumped over the fence, however R1 then stated he/she had walked through the gate. There were no injures noted. During the case management visit, LPA interviewed staff and reviewed R1's files. According to the file reviewed, it indicates that R1 has dementia and is unable to leave the facility unassisted. According to the staff interviewed, it was indicated that the latch on the gate may not have been latched all the way resulting to R1 walking out of the facility. Facility immediately conducted a head count of all residents and checked to ensure all the gates were locked. In addition, the facility had a locksmith company come and perform an inspection of all gates to ensure they were locked and latched properly, however, these precautions were conducted after R1 was able to leave the facility. Section 87411(a) Personnel Requirements, requires that facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary care and supervision to meet resident needs. In the above incident, there was an absence of supervision resulting in a resident leaving the facility. 87411(a) Personnel Requirements- $500 CIVIL PENALTY ASSESSED FOR REPEAT VIOLATION WITHIN 12 MONTHS on 2/24/2022. Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. Report is reviewed with Robert Snee, and Glynis Marcantel and a copy will be provided with appeals rights.the state’s words, verbatim · CDSS document, May 24, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: May 31, 2022

87411 Personnel Requirements: (a) acility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... Violation of this regulation is not met as evidence by: Based on staff interviews and file reviewed, it was indicated that Resident (R1) has dementia and is unable to leave the facility unassisted. In addition, it was indicated that there was no staff member who observed R1 leave the facility until R1 was observed walking toward the main office. Nevertheless, there wa no staff member present to supervise the resident. This poses a potentional health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 24, 2022

Plan of correction: Facility will have all staff members enter and exit from the main office. Staff will also be reminded to ensure gates are latched all the way if they go through the gates.

Allegation investigated: Facility is not following COVID protocols

On May 5, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the above allegation. LPA met with interim Administrator, Robert Snee, and Director of Health Services, Glynis Marcantel joined shortly therafter. LPA explained the purpose of the visit. Regarding the allegation that facility is not following COVID protocols, the complainant alleged that residents who had tested COVID positive were able to roam around the facility, dine and commingle with COVID negative residents. During the investigation, LPA reviewed facility COVID mitigation plan and interviewed staff members and it was indicated that there is a dedicated isolation unit at the facility for those who test positive for COVID, however the Administrator at the time did not want to move the positive residents, reserving the isolation area for residents who required higher level of care. In addition, interviewed staff indicated that because the residents have dementia, it was difficult to isolate them in their rooms, but the facility staff did try to ensure the positive residents were not in close proximity to the negative residents. Based on the documentation collected and interviews conducted, the facility failed to follow COVID protocols, therefore the preponderance of evidence standard has been met; therefore, this allegation is Substantiated. Deficiency of the Residential Care Elderly California Code of Regulations, Title 22, Division 6 is observed and cited on a LIC 9099D. Failure to correct the deficiencies may result in civil penalties. Report reviewed with the interim Administrator and the Director of Health Services and a copy is provided with the appeals rights is provided. Substantiatedthe state’s words, verbatim · CDSS document, May 5, 2022 · control 14-AS-20220217094555

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 12, 2022

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include ... services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on the documentation collected and interviews conducted, the facility failed to isolate COVID positive residents in the designated isolation unit at the facility. In addition interviewed staff indicated that because residents have dementia, it was difficult to isolate residents in their rooms but staff did try to ensure the positive residents were not in close proximity to the negative residents. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 5, 2022

Plan of correction: Administrator or designated staff to conduct an in-staff training in relation to COVID-19 protocols. Facility to submit an updated LIC808 Mitigation Plan for CCLD's approval IF facility has changed their covid mitigation plan.

Allegation investigated: Private caregiver was not associated to the facility while providing care to resident Facility failed to report to Licensing as required

On April 29, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Director of Health Services, Glynis Marcantel, and explained the purpose of the visit. Regarding the allegation that a private caregiver was not associated to the facility while providing care to a resident (R1): The private caregiver has been working at the facility for about 3 months. Although, the private caregiver was fingerprint cleared to work at the facility, the facility failed to associate the private caregiver. According to the staff interviewed, it was acknowledged that the facility was not aware they have to associate staff who were hired privately. Based on the information and documentation collected, the private caregiver was never associated to Silverado Senior Living-Belmont Hills. The preponderance of evidence standard has been met; therefore, this allegation is Substantiated. This violation results in a civil penalty of $100 per day x 10 days = $1,000 Regarding the allegation that the facility failed to report to Licensing as required, on February 13, 2022, a private caregiver allegedly kicked a resident (R1) while providing care to him/her. Belmont Police Department responded to the incident and a report was taken the same day. Licensing became aware of this incident on February 16, 2022, 3 days after the incident took place. According to Title 22 Regulations, 87211, Reporting Requirements, the facility is required to notify Licensing and the Local Ombudsman within 24 hours of any suspected physical abuse of an elder. (CONT. TO 9099C). Substantiated In addition, the facility is required to send Licensing a written report within seven days of the occurrence of any of the events indicated in Title 22 Regulation 87211(a)(1), (A) through (D). During the investigation, LPA was not given any proof of the facility reporting the incident between R1 and the private caregiver as required. Nevertheless, the facility failed to notify Licensing with 24 hours of the elder abuse and failed to provide Licensing a written report of the incident within 7 days. Based on the information collected, it was determined that the facility failed to report to Licensing as required. The preponderance of evidence standard has been met; therefore, the above allegation is determined to be Substantiated. Deficiency of the Residential Care Elderly California Code of Regulations, Title 22, Division 6 is observed and cited on a LIC 9099D. Failure to correct the deficiencies may result in civil penalties. Report was reviewed with Director of Health Services, Glynis Marcantel and a copy is provided with appeals right.the state’s words, verbatim · CDSS document, Apr 29, 2022 · control 14-AS-20220216135656

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Apr 30, 2022

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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) Violation of this regulation is not met as evidence by: Based on record review and information collected, it was indicated that although the private caregiver was fingerprint cleared, the facility failed to associate the caregiver to the facility. In addition, the facility was unaware they had to associate staff who were hired privately.the state’s words, verbatim · CDSS document, Apr 29, 2022

Plan of correction: Private caregiver no longer works at the facility. Facility will start associating all staff members moving foward, including privately hired caregivers and agency caregivers. Immediate civil penalty of $1,000 was issued today. $100 x 10 days = $1,000

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: May 6, 2022

87211 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below… Violation of this regulation is not met as evidenced by: Facility failed to report an incident that occurred on February 13, 2022 as required to Licensing. In addition, facility failed to submit a written report within 7 days of the occurrence date of the incident.the state’s words, verbatim · CDSS document, Apr 29, 2022

Plan of correction: Facility administrator to submit acknowledgement ot Title 22 Regulations for 87211(a), Reporting Requiements.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(b) · Plan of correction due date: May 6, 2022

87211 Reporting Requirements: (b) Any suspected physical abuse that results in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within two (2) hours as required by Welfare and Institutions Code Section 15630(b)(1). Violation of this regulation is not met as evidence by: Facility failed to report an incident of alledged abuse that occurred on February 13, 2022 as required to Licensing. This poses a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2022

Plan of correction: Facility administrator to submit acknowledgement ot Title 22 Regulations for 87211(b), Reporting Requiements.

Type of visit: Case Management - Incident

On February 24, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit regarding an Incident Report. LPA was greeted by the Director of Resident and Family Services, Diane Sapienza-Boundy, and the Director of Health Services, Glynis Marcantel, joined shortly thereafter. LPA Charitra explained the purpose of the visit. The licensee reported that on January 19, 2022, two residents were involved in an unwitnessed altercation. The staff walked into the library and saw a resident on the floor (R1). Another resident (R2) was trying to make a phone call and Resident (R1) attempted to grab the receiver. Somehow R2 hit R1 with the receiver. During the case management, LPA observed R1 being changed in her bed and R2, in the dining hall watching television. LPA interviewed staff and reviewed both resident’s files. According to the files reviewed and the documentation collected indicates that R1 has a diagnosis of Dementia with behavioral disturbances while R2 has a diagnosis of Alzheimer’s and Pseudobulbar. This is the second altercation involving R1 without any staff being present since November 2021 (see LIC809 dated 11/15/2021). In November was reported that staff had left R1 and another resident alone in the dining room, and when staff walked in observed that R1 was kicking the other resident. The report of January 19, involving R1 and R2 noted above, indicate that there was no staff member around or physically present in the library supervising the residents. The licensee has indicated that no one-on-one supervision is provided unless it is paid by the resident; however, Regulation requires the licensee to provide sufficient staff to meet the residents’ care and supervision. In the above incidents, there was an absence of supervision resulting in altercation between residents. Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. Report is reviewed with Glynis Marcantel and a copy will be provided.the state’s words, verbatim · CDSS document, Feb 24, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Mar 3, 2022

Personnel Requirements: Facility personnel shall at all times be sufficient in numbers... to provide the services necessary to meet resident needs...Sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608.... The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. Violation of this regulation is evidence by staff interviews indicating that R1 and R2, both with dementia, were alone in the library without a staff member present to supervise the residents. Staff were aware of R1’s aggressive behaviors due to 2 prior altercations involving R1; November 10, 2021 and January 18, 2022 but failed to provide additional supervision. Although it was acknowledged by the facility that R1 demonstrates violent and aggressive behaviors, and the goal will be to ensure R1 does not cause injury to self or others, the facility failed to provide an appropriate intervention to identify R1’s needs in order to avoid similar behavioral and physical situations moving forward.the state’s words, verbatim · CDSS document, Feb 24, 2022

Plan of correction: Facility will enhance monitoring and supervision with R1. Facility will address aggressive behaviors with R1's responsible party. Facility will

Type of visit: Case Management - Incident

On November 15, 2021, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced Case Management visit regarding an Incident Report that was received on November 10, 2021. LPA was greeted by the Administrator, Joan Newman and the Director of Health Services, Glynis Marcantel joined shortly thereafter. LPA Charitra explained the purpose of the visit During today's inspection LPA observed the residents. Residents were observed to be in the dining room together at this time. LPA interviewed staff and reviewed resident documents and the admission agreement. According to the admission agreement, the residents are able to remain independent, roam around the facility and actively engage in the community alone. According to the Incident Report, Resident 1 (R1) was observed to be kicking Resident 2 (R2). Residents have a diagnosis of Dementia with Behavioral Disturbances and were left alone in the dining room when the incident occurred. Based on the Administrator and the Director of Health Services, this was a one time altercation between the residents, no prior history of physical abuse. The facility does not provide one on one care to the residents unless stated otherwise. LPA reviewed the Needs and Service Plan for both R1 and R2 and it states residents do not require hands on assistance. Facility informed Ombudsman, Licensing, Physicians, and the resident's Responsible Party regarding this Incident. No deficiencies were issued. Report was reviewed with Administratorthe state’s words, verbatim · CDSS document, Nov 15, 2021

Allegation investigated: Resident sustained unexplained injuries while in care

On this day at 1100hrs Licensing Program Analysts (LPA) Jaime Vado and Komal Charitra conducted an unannounced visit to deliver findings on the allegation received. LPAs met with resident serviced direct Glynnis regarding the findings. During course of the investigation LPA discovered that the resident was discovered with the unexplained injury at the same time as another staff person. Resident had an injury and was in bed. Resdient observation rounds were being made and in between rounds a fall may have ocurred and was assisted to bed by another resident. Staff do not help residents during a fall unless assisted by a nurse. Facility reported the fall to the regional office and the injury was diagnosed at the hospital. Based on these observations, the above allegations are UNSUBSTANTIATED. Although the allegations 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 above allegations are unsubstantiated at this time. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 12, 2021 · control 14-AS-20210714115037

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff are not assisting resident with hygiene needs Resident's bathroom was dirty and malodorous Linens were not provided for resident's bed Food served to residents not of the quality to meet their needs

On this day at 1100hrs Licensing Program Analysts (LPA) Jaime Vado and Komal Charitra conducted an unannounced visit to deliver findings on the allegations received. LPAs met with resident serviced direct Glynis Marcantel regarding the findings. During the course of the investigation LPA Vado conducted made facility observations and observed R1 and her room. LPA Vado made additional observations on this day regarding resident foods and observed the buildings and grounds including resident rooms and the room of R1. R1 was observed in her bed during these observations and did not want to get out of bed. Linens are in place during these observations. The restroom of R1 was observed but LPA did not detect any odors or see any unwashed resident items in the restroom. LPA observed lunch was and saw many fresh food items served to residents such as salad, salmon, brown rice, vegetables, and fruit. LPA also inspected facility food supplies and menu and observed all are in place. During observations R1 did appear clean in clothing and hygiene needs. LPA asked about hygiene concerns and facility is able to meet her needs and R1 mostly complies when it comes to daily hygiene. Facility cannot force resident to wash hair or cut These allegations are unsubstatiated. Based on these observations, the above allegations are UNSUBSTANTIATED. Although the allegations 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 above allegations are unsubstantiated at this time. Report is reveiwed with Glenis Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 12, 2021 · control 14-AS-20210707130755

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On this day at 1100hrs, Licensing Program Analysts (LPA) Jaime Vado and Komal Charitra conducted an unannounced prelicensing inspection visit. LPAs met with diector of health services Glynis Marcantel and director of plant operations Gary and explained the purpose of today's inspection. LPAs toured the facility's buildings and grounds. Entire facility has hardwired smoke detectors and fire panel. Fire panel last inspected on 11/01/2021 and sprinklers last inspected on 11/02/2021 of which both are in full service. Facility does contain an emergency generator that will power facility for 72 hours. LPAs toured resident buildings. Twin Pines building is inspected. Room 507 was observed and water was tested at 116F. Room is fully furnished with appropriate lighting and furniture. Room is equipped with push button call system. Shower is clean and contains non-skid mat and grab bars. Fire extinguisher in dining room last inspected on 10/2021 and is charged ready for use. Carbon monoxide detector is present. Oak building is inspected. Room 405 and 411 were observed. Water was tested at 117F. Room is fully furnished with appropriate lighting and furniture. Room is equipped with push button call system. Shower is clean and contains non-skid mat and grab bars. Carbon monoxide detector is present. Maple building is inspected. Room 307 was observed and water was tested at 108F. Room is fully furnished with appropriate lighting and furniture. Room is equipped with push button call system. Shower is clean and contains non-skid mat and grab bars. Fire extinguisher in hall was last inspected on 10/2021. This building also contains resident incontinence supplies and some COVID related PPE. Carbon monoxide detector is present. Cedar building is inspected. Room 212 was observed and water was tested at 115F. Room is fully furnished with appropriate lighting and furniture. Room is equipped with push button call system. Shower is clean and contains non-skid mat and grab bars. Carbon monoxide detector is present. Additional COVID related PPE are located in a shed in the exterior area of the facility and in a closet in the library. Kitchen is inspected as well as fresh, frozen foods, and emergency food supplies. All food supplies are in place. Kitchen hood is due for cleaning and service on November 2021 but facility already has this scheduled to be conducted. Kitchen cooking range is due for cleaning as well as it was observed needing service. Cooking range and oven are operating. Facility has two wellness rooms which house the resident medications. These are observed and medications are properly stored and locked inaccessible to residents. Each resident building is equipped with a dining room and supplies are stored in refrigerators for resident use as well as juice and dining supplies. Sharps are not stored in these dining rooms. Facility is in compliance with Title 22 regulations. No citations are issued. Report is reviewed with Glenis.the state’s words, verbatim · CDSS document, Nov 12, 2021