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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005692
Report Date: 06/02/2022
Date Signed: 06/02/2022 01:50:16 PM


Document Has Been Signed on 06/02/2022 01:50 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: 24DATE:
06/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator-Dwight DunaganTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPA) Celine De Perio and Albert Marin conducted an unannounced visit to facility and met with Administrator (AD) Dwight Dunagan.

In this visit, during file review, LPAs De Perio and Marin observed that staff 1 (S1) has an expired Basic Life Support (BLS) certification. Certification issue date was on 4/21/2020, and renewal date was on 04/2022. First-Aid certification also was not found in S1's files. LPA De Perio and LPA Marin discussed with AD Dunagan CCR Section 87411 (c)(1).

No citation was issued during this visit.



LPAs De Perio and Marin conducted an exit interview with AD Dunagan.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022
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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