306005691-5-12-2026-22-AS-KSGH-DU3UHS-20260514153626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005691
Report Date: 05/12/2026
Date Signed: 05/12/2026 10:22:15 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
11/30/2025 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20251130221835

FACILITY NAME:	SILVERADO SENIOR LIVING-SAN JUAN CAPISTRANO		FACILITY NUMBER:	306005691
ADMINISTRATOR:	SHEILA FIKE		FACILITY TYPE:	740
ADDRESS:	30311 CAMINO CAPISTRANO		TELEPHONE:	(949) 240-0550
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	96	CENSUS: 80	DATE:	05/12/2026
		UNANNOUNCED	TIME BEGAN:	07:50 AM
MET WITH:	Casey Lambert		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not adequatey address a change in resident's health condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegations. LPA spoke with Stephanie Grogan, Office Services Manager and explained the purpose of the visit. Casey Lambert, Intreim Administrator arrived shorty after and met with LPA.

Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, interviews conducted, and copies of pertinent records.
It is alleged staff did not adequately address a change in resident’s health condition. Records review reflects all medication for resident (R1) has a prescription and was prescribed by a skilled propressional. Review of R1's MAR sheets reflect medication was administered as prescribed. Mediation for R1 were followed as prescribed and adjusted as prescribed by a skilled professional. R1 had an adjustment of medication on

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20251130221835

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: 05/12/2026

NARRATIVE

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October and November, 2025, when R1 had incidents. R1 had a re-assessment of their care plan in October and November of 2025. Care plan was updated in October after R1 was noted with a change in condition in the community where 911 was called to assess the situation. R1 was sent to the hospital for further evaluation and was discharged back to the community with medication change and behavior mapping. Care plan was updated in November after R1 had a behavior episode that required 911 to be called and sent out for further evaluation. R1 returned to the facility and was placed on a 1:1 care. Interviews with 4 of 4 staff stated that it was first observed that R1 had a change of condition in October and November and a new care plan was assessed based on these changes. Staff stated that medication was handled as prescribed and had changes to medication from the incident in October and when R1 was admitted to hospice. Prior to those incidents R1 did not have an observed change of condition that needed to be addressed and/or needed medication changed due to a change of condition.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation are deemed Unsubstantiated.

An exit interview was conducted with the facility representatives and a copy of this LIC9099 report was left at facility.

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

LIC9099 (FAS) - (06/04)

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