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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603165
Report Date: 11/27/2020
Date Signed: 12/10/2020 05:14:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SILVERADO SENIOR LIVING - ENCINITASFACILITY NUMBER:
374603165
ADMINISTRATOR:JOHNSON, MARIVELFACILITY TYPE:
740
ADDRESS:335 SAXONY RDTELEPHONE:
(760) 753-1245
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:122CENSUS: 87DATE:
11/27/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Marivel Johnson, AdministratorTIME COMPLETED:
12:30 PM
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Regional Manager (RM), Icela Estrada; Licensing Program Manager, Denise Powell, County of San Diego Nurse Contractor Sandra Brackman; and California Department Public Health (CDPH), Health Facility Evaluator Nurse (HFEN), Jaqueline Ruegg with the HAI Program, conducted an on-site visit. RM and team identified themselves and discussed the purpose of the visit with Administrator, Marivel Johnson.

The Department conducted a secondary on-site visit to go over the recommendations and to provide additional technical assistance. Today the team evaluated the facility's disinfection, testing surveillance, screening protocols as well as the use of personal protective equipment. During today's visit, the team interviewed Administrator Johnson and conducted a walk-through of the facility. During the walk-through, the team observed staff interacting with the residents and using PPE. The HAI team inspected stock of PPE and sanitizing supplies. A debriefing was conducted with the administrator at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with the Administrator and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to her via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Denise PowellTELEPHONE: 619-301-9770
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2020
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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