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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005693
Report Date: 05/04/2022
Date Signed: 05/04/2022 03:12:25 PM


Document Has Been Signed on 05/04/2022 03:12 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
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: 61DATE:
05/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Michael Marion - Administrator TIME COMPLETED:
03:20 PM
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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 met with Administrator Michael Marion. The purpose of today's Case Management visit was to follow-up on an Incident Report received in the Orange Regional Office on May 4, 2022 regarding Residents (R) #1 and R2.



On today's visit LPA Velazquez conducted an interview with Director of Health Services Jessica Thielmann. LPA Velazquez along with Ms. Thielmann looked in on 1 who was working on an activity with other residents. LPA Velazquez 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 811 was 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: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
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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