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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005691
Report Date:
03/16/2022
Date Signed:
03/16/2022 12:37:41 PM
Document Has Been Signed on
03/16/2022 12:37 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
770 THE CITY DR., SUITE 7100
ORANGE
,
CA
92868
FACILITY NAME:
SILVERADO SENIOR LIVING-SAN JUAN CAPISTRANO
FACILITY NUMBER:
306005691
ADMINISTRATOR:
LIGHT, ERIN
FACILITY TYPE:
740
ADDRESS:
30311 CAMINO CAPISTRANO
TELEPHONE:
(949) 240-0550
CITY:
SAN JUAN CAPISTRANO
STATE:
CA
ZIP CODE:
92675
CAPACITY:
96
CENSUS:
52
DATE:
03/16/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:15 AM
MET WITH:
Erin Light, Breanna Pritchard
TIME COMPLETED:
12:51 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry by staff. LPA met with Administrator Erin Light and Director of Health Services Breanna Pritchard. Administrator's certificate expires 3/8/2023. LPA explained the reason for the visit. LPA and Administrator and Director of Health Services toured the facility. LPA observed a 2-day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the emergency food supply for the facility is kept secured in a storage room. The kitchen is clean and organized. LPA observed all refrigerators and freezers had temperature logs and were the proper temperature. LPA observed the resident rooms had the required furnishings. LPA observed all fire extinguishers are fully charged. LPA measured the hot water temperature in 2 resident rooms. Hot water measured 115.2 degrees Fahrenheit. LPA tested the emergency signal system. Staff responded to the call in one minute. LPA observed the outdoor patio area is spacious and has multiple shaded seating areas. No bodies of water observed. LPA observed the medication room is kept secured and all medications are stored inaccessible to residents. No obstacles or hazards observed inside or outside of the facility. LPA reviewed 2 staff files and 2 resident files. Fire sprinkler system was tested on 3/15/22. Last fire drill was conducted on 1/31/22. Facility has a mitigation plan that has been approved. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
03/16/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
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