SILVERADO THOUSAND OAKS, LLC

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic services (f)(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section as R1, who has a diagnosis of dementia and is unable to leave the facility unassisted, exited the facility's front doors and was without supervision, which posed an immediate safety risk to persons in care.

Official plan of correction

Administrator indicated the staff involved in the elopement incident is no longer employed at the facility, All staffare being retrained on elopement procedures and will be participating in elopement drills.Proof of staff training & elopement drills will be sent to CCLD by POC due date.

Deadline recorded: Aug 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(2)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (2) safe and healthful living accommodations and services, as specified in Section 87307, Personal Accommodations and Services This requirement is not met as evidenced by: Based on interview and record review, the facility did not comply with the above cited section, as facility staff did not keep R2 safe from R1, resulting in R2's death, which posed an immediate health and safety risk to persons in care.

Official plan of correction

Administrator agreed to reassess residents and ensure proper placement with roommates and implement appropriate safety measures for all residents in care. Statement of understanding will be sent to CCLD by POC due date.

Deadline recorded: Mar 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463(a) The pre-admission appraisal ...shall be updated in writing as frequently as necessary...to note significant changes in condition...and to keep the appraisal accurate...shall be referred to as the reappraisal. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section, as staff were aware R1's mental condition and behavioral expressions had changed, however, no reappraisal was completed, which posed an immediate health and safety risk to persons in care.

Official plan of correction

Administrator agreed to reassess residents and ensure proper placement with roommates and implement appropriate safety measures for all residents in care. Statement of understanding will be sent to CCLD by POC due date.

Deadline recorded: Mar 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above, as the facility was short staffed and utilizing agency staffing, S1 was not trained per regulation, and staff did not act competently, which posed an immediate health and safety risk to persons in care.

Official plan of correction

Administrator agreed to ensure all agency staff utilized at the facility has sufficient training. Administrator also agreed to provide training to all staff on the topics of appropriate de-escalation behaviors, early intervention techniques, and medication interventions. Training will be ongoing and statement of understanding related to training will be sent to LPA by POC due date.

Deadline recorded: Mar 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident:The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply in the section cited above. Former resident (R1) was observed to be declining however eventually hospitilized on 9/14/2023 and tested positive for UTI and pneumonia. This posed a potiential health and safety risk to residents in care.

Official plan of correction

Current Executive Director reported that the facility residents are observed and monitored regularly and any significant change is reported accordingly. Submit a written self certification of understanding the regulation cited and your plan to ensure future compliance.Copy of in-service due by 1/3/25.

Deadline recorded: Dec 27, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

Resident Participation in Decisionmaking: (a)(3) - Prior to, or within two weeks of the resident’s admission, the licensee shall arrange a meeting with the resident, the resident’s representative,if any appropriate facility staff, and a representative of the resident’s home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility.

Official plan of correction

Current Executive Director stated the facility policy is that the residents service care plans be reviewed every 6 months or sooner if there is a significant change in condition/hospitalization and signed by all parties involved in the meeting. According to new ED that is the procedure they follow currently. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident’s condition, or once every 12 months whichever occurs first...

Deadline recorded: Dec 23, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

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: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... This requirement was not met as evidenced by: Based on interviews, records review, and video surveillance review, the licensee did not comply with the section cited above. Video surveillance showed S1 “mistreating, dragging, taunting, slapping, and air kicking” R1, which posed an

Official plan of correction

Licensee will submit a plan how they will ensure the personal rights of residents are not violated. Submit to CCL by 6/7/2024. immediate health and safety risk to residents in care.

Deadline recorded: Jun 7, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.58(a)(2)

Regulation authority

HSC

What the official deficiency says

§1569.58 Persons prohibited from being a licensee, owning beneficial interest in licensed facility, or holding certain positions or employment; grounds; notice; removal; appeal; petition for reinstatement (a) The department may prohibit from employing, or continuing the employment of, ...any employee, prospective employee, or person who is not a client and who has done any of the following: (2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of

Official plan of correction

S1 was terminated by the facility. S1 was charged with HS 11550(a) for Under the Influence of a Controlled Substance. Plan of correction complete. California. This requirement is not met as evidenced by: Based on drug testing results, the licensee did not comply with the section cited above. S1 tested positive for being under the influence of a controlled substance while working at the facility, which posed an immediate health and safety risk to residents in care.

Deadline recorded: Jun 3, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

85072(a)(b)

Regulation authority

CCR

What the official deficiency says

85072Personal Rights (a)In addition to Section 80072, the following shall apply. (b)The licensee shall insure that each client is …personal rights. To have access to telephones in order to make and receive confidential calls, provided that such calls do not infringe upon the rights of other clients and do not restrict availability of the telephone during emergencies. This requirement is not met as evidenced by: Based on the information obtained through interviews, the licensee did not comply in the section cited above, as facility staff did not provide family members with the opportunity to communicate with R1, which may pose a potential health and safety risk to residents in care.

Official plan of correction

The licensee will submit plan how they will ensure residents receive calls from calling parties in a timely manner. Submit the plan of correction to the department via email by 03/08/2024.

Deadline recorded: Mar 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)(D) - Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident.This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above, as R1's responsible party was not provided a written report of incident that occurred on 10/29, which poses a potential health, safety and personal rights risks to residents in care.

Official plan of correction

Licensee agreed to provide R1's responsible party with written report of incident that occurred on 10/29/2023 and review regulation cited and provide a statement of understanding to CCL via email by EOD 12/08/2023.

Deadline recorded: Dec 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(g)(1)

Regulation authority

CCR

What the official deficiency says

87705(g)(1) Care of Persons with Dementia. … Residents with dementia shall be allowed to keep personal grooming and hygiene items … unless there is evidence to substantiate that the resident cannot safely manage the items. This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply in the section cited above for two out of five residents (R1, R2), which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Administrator agreed to the following: 1. Secure the items by the end of the day. Inform CCL when this has taken place 2. Conduct an in-service training with care staff, regarding items that shall be inaccessible to residents with dementia. Submit sign-in sheet no later than 8/11/2023. Submit POC to CCLASCPWoodlandHillRO@dss.ca.gov, ATTN: Officer of the Day

Deadline recorded: Aug 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

1569.625(b)(1) Staff training; legislative findings; contents: ...Staff...who assist residents ... to receive appropriate training. This training shall consist of 40 hours of training …. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above in 5 out of 5 staff files, as training could not be verified as required, which poses a potential health and safety risk to residents in care.

Official plan of correction

The Administrator has agreed to do the following: 1. Submit a Plan of Action, detailing how the facility will comply with regulatory standards as it pertains to training topics and documentation Submit Plan of Action no later than 8/11/2023. Submit POC to CCLASCPWoodlandHillRO@dss.ca.gov, ATTN: Officer of the Day

Deadline recorded: Aug 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

87465(d)(3) Incidental Medical and Dental Care. The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by Based on medication review, the licensee did not comply in the section cited above for three out of five (R1, R2, R3) residents as it pertains to documentation for assisting residents with the self-administration of PRN medication, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Administrator agreed to do the following: 1. Host an in-service training, discussing topics that include but are not limited to: assisting residents with the self-administration of as-needed (PRN) medication 2. In-service must include nurses and medication technicians. Submit initial sign-in sheet by 5/18/2023. Training for all must be completed by 5/24/2023.

Deadline recorded: May 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(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) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in three (3) out of seven (7) staff (S1, S2, S3) whom had fingerprint clearance but were not associated to this location, which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2023 Plan of Correction The Administrator agreed to do the following: 1. Ensure S1, S2, and S3 are associated to this location by the end of the day.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, as there was trash observed in the first and second floor bistro and downstairs courtyard, and cushions on the second floor balcony were unclean, which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/13/2023 Plan of Correction The Administrator agreed to do the following: 1. Review protocol for staff as it pertains to facility cleanliness. Submit sign in sheet to CCL no later than 2/13/2023.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident. ... When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the ... resident's responsible person, if any. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above, as R1's responsible party was not notified of R1's refusal of medications, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Administrator agreed to do the following: 1. Submit a Statement of Understanding, indicating how the faciilty will maintain voluntary compliance with regulation 87466. Submit statement to CCL no later than 9/16/2022.

Deadline recorded: Sep 16, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)(D) Reporting Requirements. A written report shall be submitted … within seven days of the occurrence of any of the events specified ... (D) Any incident which threatens the welfare, safety or health of any resident ... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above, as reports were not submitted for all of R1’s hospitalizations, which poses a potential health and safety risk for residents in care.

Official plan of correction

The licensee has agreed to do the following: 1. Submit incident reports for R1’s incidents and/or hospitalizations for the record. Review the report for exact dates. Submit to CCL no later than 8/8/2022.

Deadline recorded: Aug 8, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

(5) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in one out of two residents (R2), which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/01/2022 Plan of Correction The Administrator agreed to do the following: 1. Within 24 hours - schedule a 1:1 with the staff person whom committed the medication error to review medication administration protocol. 2. Schedule an in-service training with staff, to discuss medication protocol - specifically regarding documentation for PRN medication and controlled substances. Submit sign in sheet and applicable documents by 3/7/2022

Official classification

Type A

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in one out of two residents (R2), which poses an immediate health and safety risk to persons in care..

Official plan of correction

POC Due Date: 03/01/2022 Plan of Correction The Administrator agreed to do the following: 1. Within 24 hours - schedule a 1:1 with the staff person whom committed the medication error to review medication administration protocol. 2. Schedule an in-service training with staff, to discuss medication protocol - specifically regarding documentation for PRN medication and controlled substances. Submit sign in sheet and applicable documents by 3/7/2022

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 1 out of 5 resident files (R1) which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2022 Plan of Correction The Administrator agreed to do the following: 1. Obtain an updated medical assessment for R1; submit no later than 3/11/2022

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411(f) Personnel Requirements - General. All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 5 staff records (S1, S2) which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/11/2022 Plan of Correction The Administrator agreed to do the following: 1. Obtain the Health Screenings for S1 and S2; submit no later than 3/11/2022

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities. Residents shall have all of the following....: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on the investigation, licensee did not comply with the section cited above, as staff were distracted and did not provide adequate supervision, resulting in R1 falling and sustaining injuries, which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Administrator agreed to do the following: 1. Submit a Plan of Action, detailing how staff are trained to respond to resident falls (witnessed and unwitnessed). In addition, detail the facility's protocol surrounding fall prevention. Submit protocol to CCL no later than 2/18/2022. 2. Review the protocol with all nursing staff. Submit the sign-in sheet and all applicable documents to CCLD no later than 2/25/2022. A civil penalty in the amount of $500 is assessed.

Deadline recorded: Feb 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465(g) Incidental Medical and Dental Care. 9-1-1 shall be telephoned immediately if an injury or other circumstance has resulted in an imminent threat to a resident’s health, including an apparent life-threatening medical crisis. This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as the facility failed to ensure that R1 received timely medical attention following R1's fall which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Administrator agreed to do the following: 1. Submit a Statement of Understanding, explaining the steps the facility will follow to avoid similar issues from happening again and to ensure compliance to Title 22 Regulations regarding emergency medical assistance.

Deadline recorded: Feb 18, 2022. A deadline is not proof that correction was completed.