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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603165
Report Date: 03/14/2022
Date Signed: 03/14/2022 01:26:04 PM


Document Has Been Signed on 03/14/2022 01:26 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, 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:0CENSUS: 0DATE:
03/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Marivel Johnson, administratorTIME COMPLETED:
01:05 PM
NARRATIVE
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Licensing Program Manager (LPM) Denise Powell conducted an unannounced case management visit in order to deliver an amended report from a previous complaint investigation. LPM met virtually with administrator Marivel Johnson, who acknowledged being a representative of the former facility which closed due to a change of ownership on 03/03/21. During this visit, LPM reviewed the contents of the amended report, consisting of a modification to the complaint allegation. A copy of the amended report along with this facility evaluation report and licensee rights, was emailed to administrator. Read receipt confirms the receipt of these documents via email.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Denise PowellTELEPHONE: 619-301-9770
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
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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