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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005693
Report Date: 07/26/2022
Date Signed: 07/26/2022 02:29:18 PM


Document Has Been Signed on 07/26/2022 02:29 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: 64DATE:
07/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:49 PM
MET WITH:Michael Marion - AdministratorTIME COMPLETED:
02:45 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, Director of Health Services Jessica Thielmann, and Assistant Director of Health Services Jasmine Brown. The purpose of today's Case Management visit was to follow-up on an Incident Report received in the Orange Regional Office on July 22, 2022 regarding Resident (R) #1 and Staff (S) #2.



On today's visit LPA Velazquez conducted an interview with S3. LPA Velazquez along with Assistant Director of Health Services Jasmine Brown conducted a partial tour of the physical plant and looked in on R1. There were no immediate health and safety concerns observed with R1 as they were visiting with family. LPA Velazquez reviewed the file of R1 and requested copies of pertinent documentation from R1 and S2's files. Per Director of Health Services Jessica Thielmann, S2 is no longer working at the facility.




There were no deficiencies issued during this Case Management visit. An exit interview was conducted with Director of Health Services Jessica Thielmann and Assistant Director of Health Services Jasmine Brown and a copy of this report along with the LIC 811s 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: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2022
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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