306005693-5-10-2024-22-AS-JTIE-D55VM8-20240510163307

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005693
Report Date: 05/10/2024
Date Signed: 05/10/2024 04:34:26 PM

Document Has Been Signed on 05/10/2024 04:34 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	SILVERADO SENIOR LIVING- NEWPORT MESA		FACILITY NUMBER:	306005693
ADMINISTRATOR:	HEATHER YOUNAN		FACILITY TYPE:	740
ADDRESS:	350 W BAY STREET		TELEPHONE:	(949) 631-2212
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92627
CAPACITY:	82	CENSUS: 53	DATE:	05/10/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Administrator, Heather Younan		TIME COMPLETED:	04:50 PM

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On May 10, 2024, at 8:30am, Licensing Program Analysts (LPAs) Jenifer Tirre and Edward Kim conducted an unannounced required 1-year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Tirre and Kim met with Administrator (AD) Heather Younan and explained the purpose of the visit.

The facility census is fifty-three (53) residents. The facility is approved for eighty-two (82) non-ambulatory and hospice waiver for twenty (20) residents. The facility is a two-story structure located in a residential neighborhood. It consists of the following: forty-one (41) resident bedrooms, forty-six (46) bathrooms, 4 dining areas, kitchen, and outside covered patio area.

Around 9:20am LPAs Tirre and Kim toured inside and outside grounds of the physical plant with AD Younan. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Three resident’s rooms were inspected. Bathrooms were found within Title 22 regulations and were clean and operational. The water temperature measured at 111.2-118.5 degrees F. A comfortable temperature of 68-74 degrees F was maintained in the facility.

LPA's observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food & water was observed to be adequate. Three fire extinguishers were checked and all were charged and mounted. Facility provided documentation by Fire Safety Service confirming all smoke detectors, and carbon monoxide were operable during facility's last conducted Fire/Safety Drill on March 6, 2024. Drills are done quarterly. A working telephone (949-631-2212) remains available. Proof of Liability Insurance is valid (7/1/2023-7/1/2024). First Aid Kit contained all the necessary elements.

Evaluation Report Continues on LIC 809-C

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SILVERADO SENIOR LIVING- NEWPORT MESA	FACILITY NUMBER: 306005693
	VISIT DATE: 05/10/2024

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During the visit, LPA's observed the facility's infection control practices. LPA's observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA's observed Department posters were posted. The Administrative Certificate expires June 9, 2025 for Heather Younan.

During the visit, LPAs conducted a full audit of all staff files, resident files, and medications. LPAs conducted three (3) resident interviews and six (6) staff interviews.

No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a copy of this report was provided to Administrator Younan.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024

LIC809 (FAS) - (06/04)

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