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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005692
Report Date: 07/13/2022
Date Signed: 07/13/2022 02:33:39 PM


Document Has Been Signed on 07/13/2022 02:33 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:
07/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:Administrator Diwght DunaganTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Albert Marin made an unannounced visit, LPA met with Administrator Dwight Dunagan, and stated the purpose of the visit.

LPA toured the facility and observed six residents in care in the TV room doing pet club; three residents doing arts and crafts and three residents engaged in music therapy in the dining area. Activities were supervised by staff members. Two residents were observed in the outdoor features of the facility. After the tour, LPA conducted random interviews and file review.

For this visit, no deficiency was noted in areas observed. No citation was issued.

LPA Marin conducted an exit interview with AD 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: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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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