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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005691
Report Date: 08/13/2026
Date Signed: 08/13/2026 01:32:35 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/05/2026 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20260805161645
FACILITY NAME:SILVERADO SENIOR LIVING-SAN JUAN CAPISTRANOFACILITY NUMBER:
306005691
ADMINISTRATOR:TANA MCMILLONFACILITY TYPE:
740
ADDRESS:30311 CAMINO CAPISTRANOTELEPHONE:
(949) 240-0550
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:96CENSUS: 77DATE:
08/13/2026
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Casey LambertTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Licensee did not make available confidential information upon written consent from resident's designated representative
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry and explained the reason for the visit.

During the course of the investigation, LPA interviewed Administrator. Regarding the allegation that licensee did not make available confidential information upon written consent from resident's designated representative, the investigation revealed the following: Resident 1's (R1) designee requested a copy of the resident's record on July 30, 2026. Administrator confirms receiving request in the late evening on July 30, 2026. Administrator notified the home office same day. Administrator began to gather the records for submittal to home office on August 3, 2026. As of August 10, 2026, R1's designee had not received the requested records violating ยง1569.269(a)(21) which states resident records must be provided upon request within two business days. CONTINUED ON LIC 9099C DATED 08/13/2026
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
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 3
Control Number 22-AS-20260805161645
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
VISIT DATE: 08/13/2026
NARRATIVE
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 Based on interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegation is deemed Substantiated. Deficiency being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260805161645
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/20/2026
Section Cited
HSC
1569.269(a)(21)
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Residents of residential care facilities for the elderly shall have all of the following rights: To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days..This req is not met as evidenced by:
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Licensee agrees to forward proof that records have been provided to LPA by POC due date.
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Based on interviews conducted, Licensee failed to ensure R1's records were provided within two business days which poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3