306005693-5-4-2022-22-AS-SSAS-CH7TN8-20220811145215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005693
Report Date: 05/04/2022
Date Signed: 05/04/2022 03:08:44 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/22/2022 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220322095946

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: 61	DATE:	05/04/2022
		UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Michael Marion - Administrator		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Authorized representative was not informed of resident treatment
Residents were given medication without a doctor's order

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Patricia Velazquez conducted a subsequent complaint visit to investigate the above allegations. LPA Velazquez was allowed entry into the facility and met with Administrator Michael Marion.

On today's visit LPA Velazquez reviewed facility, staff, and resident records. LPA Velazquez also conducted interviews with staff and residents. During the course of the investigation LPA reviewed facility, staff, and resident records. Records reviewed included resident and staff rosters, staff schedules, staff training records, resident physician's reports, medication administration records, telephone/fax orders with a doctor's signature requesting medications for residents, preplacement appraisal information, resident appraisals, comprehensive assessments, and resident admission agreements. LPA Velazquez also conducted interviews with staff and residents who were not able to corroborate the above allegations. The facility works primarily with one pharmacy that will not fill a prescription for a medication without a physician's order in place.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (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.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20220322095946

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/04/2022

NARRATIVE

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Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the following allegations: Authorized representative was not informed of resident treatment, and Residents were given medication without a doctor's order are deemed unsubstantiated.

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 811s 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: 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

LIC9099 (FAS) - (06/04)

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