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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320514
Report Date: 05/02/2025
Date Signed: 05/02/2025 05:12:18 PM

Document Has Been Signed on 05/02/2025 05:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SILVERADO ROLLING HILLSFACILITY NUMBER:
198320514
ADMINISTRATOR/
DIRECTOR:		GIUNTO, TAYLORFACILITY TYPE:
740
ADDRESS:2455 PACIFIC COAST HWYTELEPHONE:
(949) 240-7200
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: 68CENSUS: 41DATE:
05/02/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Taylor GiuntoTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On 05/02/2025 at 9:00AM, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an announced Pre-Licensing visit to the facility listed above. LPA met with Administrator Taylor Giunto and Administrator Trainee Christina Hale, and the purpose of today’s visit was explained.
An application was submitted to CCLD on 07/09/24 for a Change of Ownership. The facility is a Residential Care Facility for the Elderly serving residents aged 60 and over. The facility was granted Fire Clearance on 03/15/2025 for 68 Bedridden residents with a total capacity of 68.
Physical Plant/Structure The facility is a two story building in a commercial area. The facility consists of the following: the entrance has a lobby with a sitting area, restroom, meeting room, sitting room, administrative offices, and reception area. The first floor has 15 resident rooms with bathrooms, an activity area, dining area, television area, sitting area, bistro area, quite room for physical therapy, linen storage room, supply room, housekeeping storage room, salon, restroom, Activity Director office, medication room, industrial kitchen, staff lounge area, and enclosed patio. The second floor has 32 resident rooms with bathrooms, an activity area, dining area, television area, sitting area, bistro area, linen storage room, supply
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

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

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

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

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

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

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

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

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

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

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SILVERADO ROLLING HILLS
FACILITY NUMBER: 198320514
VISIT DATE: 05/02/2025
NARRATIVE
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room, housekeeping storage area, spa, restroom, Health and Wellness director office, medication room, and Wellness Office. During the facility inspection, LPA did not observe any bodies of water on the premises. The outside patio area has tables, chairs, and umbrellas. The gates exiting the patio are egressed and work properly. All outside walkways were observed to be clean, clear, and free of obstructions, debris, and hazards. All windows, screens, and blinds were observed to be in good repair.
Resident Rooms LPA inspected all resident rooms and observed them to be clean and in good repair. LPA observed all resident rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for personal belongings. Residents have the option to furnish their room how they would like, or the facility has furniture available if residents need it. LPA observed the beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. Residents do have the option to use their personal linens, or the facility has a supply of linens available. LPA observed an additional supply of linens in a linen storage room. All linens and mattresses were observed in good repair. All resident rooms were observed with ample lighting.
Kitchen LPA observed the industrial kitchen to be clean and sanitary during time of visit. LPA observed all appliances to be operable and in good repair. LPA observed an ample supply of cookware, dishware, and cutleries in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. All foods were observed properly dated, labeled, packaged, and stored. The freezer temperature measured -2-degrees Fahrenheit, and the refrigerator temperature measured 39-degrees Fahrenheit. LPA observed knives and sharps to
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SILVERADO ROLLING HILLS
FACILITY NUMBER: 198320514
VISIT DATE: 05/02/2025
NARRATIVE
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be secured and are inaccessible to residents. LPA observed menus posted in the dining rooms. The first and second floor Bistro areas were observed clean and sanitary. LPA observed a supply of snacks and drinks available for residents at any time. LPA observed cleaning supplies to be secured in a locked storage room and are inaccessible to residents. All trash cans were observed with tight fitting covers.
Common Rooms LPA observed all common rooms to have ample seating to accommodate residents. LPA observed dining areas to have ample tables and chairs to accommodate residents. In the activity areas, LPA observed tables and chair available to accommodate residents. LPA observed an ample supply of arts, crafts, exercise equipment, games, and activities stored in a storage room on the first and second floor. LPA observed a daily and monthly activity schedule posted in the activity areas. The facility was observed appropriately furnished during the time of visit. All walkways and hallways in the facility were observed to be clean, clear, and free of hazards and obstructions. The facility was kept at a comfortable temperature. All rooms and hallways were observed to have ample lighting.
Files LPA observed resident medical files secured in the locked wellness room and are inaccessible to residents. Resident Administrative files were observed secured in a locked cabinet in an administrative office. LPA observed staff files secured in a locked cabinet in an administrative office. The facility does not handle resident’s finances.
Medications LPA observed medications secured in locked medication cart on each floor. Medications are inaccessible to residents. LPA observed medications to be in their original packaging. LPA observed a fully stocked First Aid kit with a current manual, in both medication rooms. LPA observed additional First Aid supply secured in the medication room.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SILVERADO ROLLING HILLS
FACILITY NUMBER: 198320514
VISIT DATE: 05/02/2025
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Safety LPA tested smoke detectors on each floor and carbon monoxide detectors in each resident unit and found them to be operable. The facility has fire doors that are triggered to close automatically when the fire alarm goes off. LPA observed multiple fully charged fire extinguisher last serviced on 03/09/25, throughout the facility. The Fire Safety Inspection was conducted by the Torrance Fire Department on 03/13/25. The last emergency drill was conducted on 02/04/25. LPA observed an evacuation chair at the top of the stairwell LPA observed the facility’s Emergency and Disaster Plan posted and last updated on 08/01/24. LPA observed emergency flashlights with every fire extinguisher. The generator was tested and ran. LPA observed logs indicating the generator is ran monthly for 30 minutes. The facility has a working landline telephone. LPA observed all required posting, posted throughout the facility. LPA tested the signal system by pressing resident’s pendants. LPA received and reviewed a copy of the liability insurance through Acord.

LPA and Administrator reviewed and discussed Component III.

LPA did not observe or cite any technical advisory deficiencies.

An exit interview was conducted with Administrator Taylor Giunto and Administrator Trainee Christina Hale and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025
LIC809 (FAS) - (06/04)
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