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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005692
Report Date: 02/24/2025
Date Signed: 02/24/2025 03:15:52 PM

Document Has Been Signed on 02/24/2025 03:15 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-TUSTIN HACIENDAFACILITY NUMBER:
306005692
ADMINISTRATOR/
DIRECTOR:
ERIN LIGHTFACILITY TYPE:
740
ADDRESS:240 E 3RD STREETTELEPHONE:
(714) 832-7900
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 42TOTAL ENROLLED CHILDREN: 0CENSUS: 23DATE:
02/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Benjamin Velasquez- Administrator and Breanna Creekmore - Director of Health Services TIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct an annual inspection. LPA was greeted and granted entry into the facility by Director of Health Services Breanna Creekmore and explained the reason for the visit. Administrator (AD) Benjamin Velasquez arrived shortly after.

The facility is a single story building with an approved fire clearance of forty-two non-ambulatory residents of which eighteen may be on hospice. The facility currently has a census of twenty-three residents in care.

During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing hot water temperature in three bathrooms, and testing auditory delayed egress devices. The hot water temperature measured between 106.7 and 112.6 degrees Fahrenheit. LPA Mendivil observed the facility to have two day perishables and seven day non-perishables, facility stores emergency food and water in dry storage. LPA observed medications in a locked med-cart located inside of locked wellness room. LPA Mendivil reviewed Electronic Medication Administration Record for two residents, and medications were given as prescribed. LPA observed two separate activity calendars. LPA observed residents throughout the common areas and in their bedrooms. LPA observed four residents rooms and all had required items including bed, chair, dresser/closet and ample lighting.LPA Mendivil reviewed four resident files and four staff files and all files contained the required documentation. Facility had an annual testing of fire/carbon monoxide conducted on 03/29/2024. The facility conducted a fire drill on 01/16/2025.

Based on the observations made during today’s visit no deficiencies cited on this date. An exit interview was conducted with AD Benjamin Velasquez and Director of Health Services Breanna Creekmore and a copy of this report was provided.
Alisa OrtizTELEPHONE: (714) 703-4084
Andrea MendivilTELEPHONE: 714-703-2738
DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2025
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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