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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005691
Report Date: 09/11/2025
Date Signed: 09/11/2025 10:15:17 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2025 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20250307105005
FACILITY NAME:SILVERADO SENIOR LIVING-SAN JUAN CAPISTRANOFACILITY NUMBER:
306005691
ADMINISTRATOR:SHEILA FIKEFACILITY TYPE:
740
ADDRESS:30311 CAMINO CAPISTRANOTELEPHONE:
(949) 240-0550
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:96CENSUS: DATE:
09/11/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Sheila Fike TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did ensure resident's needs were being met.
Staff did not seek medical attention to resident.
Staff did not safeguard resident's personal belongings.
Staff did not issue responsible party a refund.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to deliver findings regarding the allegations. LPA met with Executive Director Sheila Fike and explained the purpose of the visit.During the course of the investigation, LPA conducted interviews with three staff members, three residents, and reviewed relevant facility records.The first allegation stated that staff did not ensure residents’ needs were being met. LPA conducted interviews with three staff members and three residents, all of whom denied the allegation.The second allegation stated that staff did not seek medical attention for a resident. LPA interviewed three staff members and three residents, all of whom denied the allegation. In addition, LPA searched the Community Care Licensing database for any Special Incident Reports (SIRs) submitted by the facility and found no record of reporting related to the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
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 2
Control Number 22-AS-20250307105005
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SILVERADO SENIOR LIVING-SAN JUAN CAPISTRANO
FACILITY NUMBER: 306005691
VISIT DATE: 09/11/2025
NARRATIVE
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The third allegation stated that staff did not safeguard a resident’s personal belongings. LPA conducted interviews with three staff members and three residents, all of whom denied the allegation. LPA also reviewed the Resident Inventory and confirmed that the alleged missing item was located in the laundry and subsequently returned to the resident. LPA contacted the reporting party, who confirmed the item had been received.The fourth allegation stated that facility failed to issue a refund to a responsible party. LPA reviewed facility records and email correspondence with the facility’s home office, which confirmed that a refund check (check number 5638) was issued on March 19, 2025, and cleared on March 25, 2025.Based on evidence obtained through interviews, record reviews, and observations, there is not a preponderance of evidence to support that the alleged violations occurred. Therefore, the allegations are deemed unsubstantiated. This means that while the reported concerns may have occurred or may be valid, there is insufficient evidence to prove the facility violated applicable regulations.No deficiencies were cited during today’s visit. An exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2