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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005693
Report Date:
03/25/2022
Date Signed:
03/25/2022 09:54:08 AM
Document Has Been Signed on
03/25/2022 09:54 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 MESA
FACILITY NUMBER:
306005693
ADMINISTRATOR:
MICHAEL MARION
FACILITY TYPE:
740
ADDRESS:
350 W BAY STREET
TELEPHONE:
(949) 631-2212
CITY:
COSTA MESA
STATE:
CA
ZIP CODE:
92627
CAPACITY:
82
CENSUS:
59
DATE:
03/25/2022
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
09:31 AM
MET WITH:
Michael Marion - Administrator
TIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit Silverado Senior Living - Newport Mesa. LPA Velazquez was allowed entry into the facility and met Administrator (AD) Michael Marion. The purpose of today's visit was to follow-up on 2 Incidents reported to Licensing on 03/04/2022 and on 03/15/2022 regarding residents at the community.
During today's visit LPA Velazquez requested copies of pertinent resident records. LPA Velazquez also conducted a brief interview with Administrator Michael Marion.
There were no deficiencies issued during today's Case Management visit. An exit interview was conducted with Administrator Michael Marion. A copy of this report along with the LIC 811 were provided at the time of this visit.
SUPERVISOR'S NAME:
Sheila Santos
TELEPHONE:
(713) 334-2062
LICENSING EVALUATOR NAME:
Patricia Velazquez
TELEPHONE:
(949) 236-0556
LICENSING EVALUATOR SIGNATURE:
DATE:
03/25/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/25/2022
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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