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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005693
Report Date: 05/25/2022
Date Signed: 05/25/2022 11:22:15 AM

Document Has Been Signed on 05/25/2022 11:22 AM - 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- NEWPORT MESAFACILITY NUMBER:
306005693
ADMINISTRATOR:MICHAEL MARIONFACILITY TYPE:
740
ADDRESS:350 W BAY STREETTELEPHONE:
(949) 631-2212
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 82CENSUS: 58DATE:
05/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Mike Marion - Administrator
Jessica Thielmann - Director of Health Services		TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to Silverado Senior Living - Newport Mesa. LPA Velazquez was allowed entry into the facility and initially met with Administrative Assistant Yesenia Avelar-Cartagena. Administrator Michael Marion and Director of Health Services Jessica Thielmann arrived later to assist with the visit. The purpose of today's Case Management visit was to follow-up on 2 Incident Reports received in the Orange Regional Office on May 16, 2022 regarding Residents (R) #1 and R2.



On today's visit LPA Velazquez conducted an interviews with staff and R2. There were no immediate health and safety concerns observed with R2. Per the facility R1 is currently hospitalized. LPA Velazquez reviewed the files of R1 and R2 and requested copies of pertinent documentation from R1 and R2's files.





There were no deficiencies issued during this Case Management visit. An exit interview was conducted with Administrator Michael Marion and Director of Health Services Jessica Thielmann and a copy of this report along with the LIC 811s were provided at the time of this visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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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