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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005693
Report Date: 02/25/2022
Date Signed: 02/25/2022 11:32:43 AM


Document Has Been Signed on 02/25/2022 11:32 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:MENCHACA, LOURDESFACILITY TYPE:
740
ADDRESS:350 W BAY STREETTELEPHONE:
9496312212
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:82CENSUS: 56DATE:
02/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Mike Marion - AdministratorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to Silverado Senior Living - Newport Mesa. The purpose of today's visit was to conduct a Required 1 Year inspection. LPA Velazquez was allowed entry into the facility and met with Administrator (AD) Mike Marion. The facility is licensed for 82 non-ambulatory residents. The facility also has a hospice waiver for 20 residents. The entire facility is a Memory Care community. LPA was provided with a copy of the most recent Fire inspection report which was conducted on July 30, 2021 and includes inspection of portable fire extinguishers. The last emergency disaster drill was conducted on December 8, 2021. LPA was also provided with a copy of the most recent liability insurance policy.


At 9:28 AM LPA Velazquez conducted a tour of the physical plant along with AD Marion and Director of Health Services (DHS) Breanna Pritchard. The facility consists of 2 stories with resident rooms each with their own or shared bathrooms on the first floor. The upstairs has a conference room as well as storage areas. There are 4 activity areas, 3 dining rooms, kitchen, 1 nail bar, 3 courtyards, a lobby area and a bistro. The resident bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each resident comfortably. Resident bath towels and personal hygiene supplies were adequately stocked. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew and a non-skid surface was in place. LPA Velazquez tested the hot water temperature in 10 resident bathrooms and the temperature ranged from 108.3 degrees Fahrenheit to 123.4 degrees Fahrenheit which was verified by AD Marion. LPA Velazquez inspected the kitchen along with AD Marion and HSD Pritchard. Perishable and non-perishable food supply was checked and adequately stocked at the time of the visit. Emergency food supply was also adequately stocked. PPE supplies were checked and adequately stocked at the time of this visit. Toxins, sharps, and medications were locked and inaccessible to residents.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
VISIT DATE: 02/25/2022
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The delayed egress doors were tested and found operational. First Aid kit was checked and found to be in order. The facility also had a First Aid manual.

LPA Velazquez along with AD Marion and HSD Pritchard toured the outside grounds and no bodies of water were observed. There was shading and sufficient seating for residents. Walkways around the facility were clear of hazards There were no security bars or weapons on the premises.

No resident or staff files were reviewed at the time of this visit.



There were no deficiencies issued during this Required 1 Year inspection. An exit interview was conducted with AD Mike Marion, HSD Breanna Pritchard, and Director of Health Services Jessica Thielmann and a copy of this report along with a copy of the LIC 9102 were provided at the time of this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia VelazquezTELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
LIC809 (FAS) - (06/04)
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