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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005693
Report Date: 02/08/2021
Date Signed: 02/10/2021 12:29:46 PM

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- NEWPORT MESAFACILITY NUMBER:
306005693
ADMINISTRATOR:MENCHACA, LOURDESFACILITY TYPE:
740
ADDRESS:350 W BAY STREETTELEPHONE:
(949) 240-7200
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:82CENSUS: 43DATE:
02/08/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Lourdes MenchacaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Lydia Martinez contacted the facility via telephone to conduct a Pre-Licensing visit via Face Time due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call with Administrator Lourdes Menchaca. A Change of Ownership to operate a Residential Care Facility for the Elderly was submitted to the Central Applications Bureau (CAB) for a capacity of 82 non-Ambulatory residents. The Costa Mesa Fire Department - Station 3 conducted a Fire Safety Inspection on 01/15/2020 and granted the fire clearance. A virtual tour of the physical plant was conducted inside and out with Administrator Menchaca and Director of Health Services, Breanna Pritchard, and the following was observed:

Facility serves all Memory Care residents. Building has 41 rooms designed to accommodate up to 82 non-Ambulatory residents. Current census is 43. The entire building is secured with delayed egress exits. The entire premises including the kitchen, dining room, activity room, medication room, laundry, patios, storage areas and a sampling of resident rooms were toured. Fire extinguishers were mounted and charged. Smoke detectors are centrally wired and are checked by the Fire Department. Facility supplies furnishing but residents can furnish their own rooms. There was an adequate supply of fresh linen. Medication room is locked for centrally stored medications and locked area for toxins and cleaning supplies. A call system is in place. The delayed egress system was tested. As this is an existing facility, food supply was checked. This facility has also submitted a hospice waiver request and a plan to care for residents with dementia. Physical plant safeguards have been checked. The Component III Requirement has been waived as the Administrator is experienced with facility operations and is in good standing.

The Pre-Licensing is complete and this facility has no deficiencies. License will be granted upon approval by the CAB. An exit interview was conducted and a copy of this report will be provided to Administrator Menchaca via email to sign and return to LPA Martinez via email.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021
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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