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

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

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