374604255-4-13-2023-18-AS-JARA-CQUUSM-20230413155034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604255
Report Date: 04/13/2023
Date Signed: 04/13/2023 03:50:55 PM

Document Has Been Signed on 04/13/2023 03:50 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	SILVERADO SENIOR LIVING-ESCONDIDO		FACILITY NUMBER:	374604255
ADMINISTRATOR:	MCMILLON, TANA		FACILITY TYPE:	740
ADDRESS:	1500 BORDEN ROAD		TELEPHONE:	(760) 737-7900
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY: 104		CENSUS: 65	DATE:	04/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Administrator, Kellie Smith		TIME COMPLETED:	03:30 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Janira Arreola and Cheryl Goodrich conducted an unannounced annual required visit on 4/13/2023 at 10:46 a.m. LPA met with Administrator Kellie Smith, who was informed of the purpose of the visit.

The facility is comprised of a one story building licensed for memory care. Total capacity of (104) residents, all of which may be non-ambulatory. The residents served are elderly ages 60 and above. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted (5)staff and (5)resident interviews. LPA observed the following:

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen. LPA observed gloves and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan. LPA observed PPE supplies at the facility. (1) staff training for infection control training was unable to be located at the time of the visit. This was documented on a deficiency page along with plan of correction.

Physical Plant/Planned activities: LPA observed the resident bedrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. No pools are present at the facility. Laundry room was observed to be locked and equipment was observed to be in working condition.

Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SILVERADO SENIOR LIVING-ESCONDIDO	FACILITY NUMBER: 374604255
	VISIT DATE: 04/13/2023

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Care & Supervision/Administration: LPA observed adequate staff are present for the supervision of residents. Emergency exiting plans, personal rights, and ombudsmen were found posted in the facility. The listed administrator, possesses a current administrator's certificate. LPA reviewed the facility's liability insurance and found that that it was current.

Record Review and Resident/Staff Files: LPA reviewed (5) staff files. All staff have updated training along with CPR/First Aid Certification. (1) was found to not have infection control training. Five (5) resident files were reviewed, and found all required documents were present.

Health Related Services/ Incidental Medical Services: All resident medications were locked in a medication room with medication carts. LPA observed the facility has a first aid kit on the premises and had a sharps container for needles.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility last disaster drill on 4/7/2023, which met the department requirements. LPA observed all facility exits, and evacuation routes were posted at the facility. LPA observed the facility's emergency supplies along with disaster preparedness binder.

An exit interview was conducted where a copy of this report was reviewed and provided to Administrator, Kellie Smith.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/13/2023 03:50 PM - It Cannot Be Edited

Created By: Janira Arreola On 04/13/2023 at 03:26 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SILVERADO SENIOR LIVING-ESCONDIDO	FACILITY NUMBER: 374604255
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87470(c)(1)(C)(1.)

87470 Infection Control Requirements (c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. (1) The Infection Control Plan shall include all of the following: (C) An Infection Control Training Plan. 1. Initial training requirements for new facility staff shall be addressed in the plan, with training to be provided by the Infection Preventionist before staff works independently with residents. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above with (1) staff that did not have infection cotnrol training. The LPAs requested the training from administrator, who was unable to locate it at the time of the visit. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	The administrator agreed to send the LPA the infection control training to the LPA by the P{OC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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

SUPERVISOR'S NAME:

Joel Esquivel

LICENSING EVALUATOR NAME:

Janira Arreola

LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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