Silverado Thousand Oaks, Llc

Facility personnel sufficiency and competence

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.

Update reappraisal at required intervals

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.

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 ServicesThis 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.

Review and revise record after changes

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.

Regular observation and documentation of resident changes

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.

Protection from punishment and intimidation

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

§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

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.

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.

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.

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.

Record dose details and resident medication response

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.

Maintain facility in clean, safe, sanitary condition

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.

Obtain required California clearance or exemption

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.

Regular observation and documentation of resident changes

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.

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.

Health screening and fitness requirements

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.

Obtain baseline medical assessment before resident admission

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.

Limit staff assistance with self-administered drugs

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.

Document each PRN medication dose taken

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..

Call 9-1-1 for imminent health threats

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.

Right to sufficient care and qualified staff

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.

Maintain facility in clean, safe, sanitary condition

87303(a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times.This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above, as the egress connection for the service door was inoperable, as R1 left the facility without triggering an alarm, which poses an immediate health and safety risk to residents in care.

Care and supervision as defined by statute and rules

87464(f)(1) Basic Services. (f) Basic services shall at a minimum include: (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 records review, the licensee did not comply with the section cited above, as the facility failed to ensure that all exits were secure to prevent elopements, which poses an immediate health and safety risk to residents in care.