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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005692
Report Date: 02/17/2022
Date Signed: 02/17/2022 01:01:39 PM


Document Has Been Signed on 02/17/2022 01:01 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:ERIN LIGHTFACILITY TYPE:
740
ADDRESS:240 E 3RD STREETTELEPHONE:
(714) 832-7900
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:42CENSUS: 25DATE:
02/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Dwight DunaganTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced required annual inspection in this facility. LPA met with Administrator (AD) Dwight Dunagan and stated the purpose of this visit.

The facility is a single level structure and licensed for 42 non-ambulatory and with hospice waiver for 18. For this visit, there was one resident under hospice care.

About 11:00 AM, LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. LPA toured the interior and exterior portions of the facility. LPA observed posted activities and menu in common areas. LPA observed about ten residents in participating in the morning activities with staff members on the floor. There were 18 private and 31 shared resident's rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke alarm and sprinkler system were last inspected in September 2, 2021 by a contracted company; and systems were tested to be operational. LPA randomly observed carbon monoxide detectors present in resident's rooms and tested to be operational. Alert or call system in Rooms 4 and 30 were tested and observed to be operational. Staff members came in within about two minutes to reset the system. Bathrooms were observed to be in good repair; and provided with handrails and non skid floor surfaces Hot water was measured between 110 - 115 degrees Fahrenheit. Kitchen appeared clutter free. LPA received and reviewed the copy of the Dietitian Report issued last February 16, 2022. Facility met the minimum two-day perishable and seven-day non-perishable food stock requirements. Medications are stored in the medication room. Cleaning and laundry supplies were rendered inaccessible to residents in care. Fire extinguishers were mounted and charged. For the exterior portion, facility had outside furniture in good repair. Delayed egress doors and auditory exit alarms were tested to be operational. Facility vehicle was inspected and observed to have fire extinguisher and first aid kits in place. LPA Marin reviewed the COVID 19 mitigation plan of the facility.

For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

LPA Marin advised AD Dunagan to use the general email address:CCLASCPOrangeCountyRO@dss.ca.gov

LPA Marin conducted an exit interview with AD Dwight Dunagan and copy of this report was left in the facility.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2022
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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