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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604255
Report Date: 06/12/2023
Date Signed: 06/12/2023 02:26:50 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/07/2023 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230607153129
FACILITY NAME:SILVERADO SENIOR LIVING-ESCONDIDOFACILITY NUMBER:
374604255
ADMINISTRATOR:MCMILLON, TANAFACILITY TYPE:
740
ADDRESS:1500 BORDEN ROADTELEPHONE:
(760) 737-7900
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:104CENSUS: 62DATE:
06/12/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kellie Smith, Executive DirectorTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide proper care for resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA) Tricia Danielson and Cheryl Goodrich arrived unannounced to initiate an investigation into the allegations listed above. LPAs met with Executive Director Kellie Smith and explained the purpose of the allegations.
During today's visit, LPAs interviewed three (3) staff, one (1) resident, and reviewed and obtained copies of pertinent documents. Regarding the allegation "Staff did not provide proper care for resident", it was alleged that Resident #1 (R1) was recently observed to be pantless and laying on a urine covered mattress with no sheet, and smeared feces was also observed on the toilet seat of R1's bathroom and walls of their room. Interview with R1 revealed they recalled the day of the incident and reported they had removed their sweat pants themselves and had "dribbled" urine on the mattress. R1 also reported they had a "heroic" bowel movement that they had dug out of their rectum with their finger. R1 reported they had not activated the call light for staff assistance nor did they seek staff assistance in any way. Interview with Staff #1 (S1) revealed during rounds, S1 found R1 unclothed from the waist down on a bare mattress, attempting to slide out of bed and was covered in feces. When S1 attempted to assist R1 back up on the bed, R1 refused assistance and asked S1 to seek assistance for them from female staff instead. Interview with S1 revealed R1 had been observed to be laying on their sheeted (CONTINUED ON LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 18-AS-20230607153129
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SILVERADO SENIOR LIVING-ESCONDIDO
FACILITY NUMBER: 374604255
VISIT DATE: 06/12/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
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12
13
14
15
16
17
18
19
20
21
22
23
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27
28
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31
32
(CONTINUED FROM LIC9099)
mattress, fully clothed, thirty (30) minutes prior to the incident and was not covered in feces or wet with urine. Interview with R1 revealed they had no recollection of the incident of refusing assistance from S1 and requesting assistance only from female staff. R1 also reported that they have memory issues and don't remember all things.

Although the allegation may have happened or are valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names list.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/07/2023 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230607153129

FACILITY NAME:SILVERADO SENIOR LIVING-ESCONDIDOFACILITY NUMBER:
374604255
ADMINISTRATOR:MCMILLON, TANAFACILITY TYPE:
740
ADDRESS:1500 BORDEN ROADTELEPHONE:
(760) 737-7900
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:104CENSUS: DATE:
06/12/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kellie Smith, Executive DirectorTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff left resident without clothes
Staff did not provide clean linens for resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Tricia Danielson and Cheryl Goodrich arrived unannounced to initiate an investigation into the allegation listed above. LPAs met with Executive Director Kellie Smith and explained the purpose of the allegations.
During today's visit, LPAs interviewed three (3) staff, one (1) resident, and reviewed and obtained copies of pertinent documents. Regarding the allegation "Staff left resident without clothes", it was alleged that R1 had been observed pantless on their bed. Interview with R1 revealed they recalled the day of the incident and reported they had removed their sweat pants themselves while in their room. Interview with S1 revealed R1 had been observed to be laying on their bed fully clothed, thirty (30) minutes prior to the incident. This agency has investigated the complaint alleging "Staff left resident without clothes". Regarding the allegation "Staff did not provide clean linens for resident", it was alleged that R1 was not provided a sheet for their mattress. Interview with S1 revealed on the day of the incident, R1 had been observed to be laying fully clothed on a sheeted mattress thirty (30) minutes prior to R1 being found unclothed from the waist down on the mattress without a sheet. Interview with R1 revealed they had no (CONTINUED ON LIC9099-C)
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20230607153129
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SILVERADO SENIOR LIVING-ESCONDIDO
FACILITY NUMBER: 374604255
VISIT DATE: 06/12/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(CONTINUED FROM LIC9099-A)
recollection of laying on the mattress without a sheet. R1 also reported that they have memory issues and don't remember all things. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names list.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4