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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604255
Report Date: 03/12/2024
Date Signed: 03/12/2024 05:51:59 PM

Document Has Been Signed on 03/12/2024 05:51 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SILVERADO SENIOR LIVING-ESCONDIDOFACILITY NUMBER:
374604255
ADMINISTRATOR:KELLIE SMITHFACILITY TYPE:
740
ADDRESS:1500 BORDEN ROADTELEPHONE:
(760) 737-7900
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: 104CENSUS: 60DATE:
03/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Michael Zuletta, Administrator In TrainingTIME COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted an unannounced annual required visit. LPA met with Administrator In Training, Michael Zuletta and Family Ambassador Dementia Care Specialist, Shanyn Chapman, who were informed of the purpose of the visit.

The facility is comprised of a one story building licensed for memory care. Total capacity of (104) residents, all of which may be non-ambulatory. The residents served are elderly ages 60 and above. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted (4) staff and (4) resident interviews. LPA observed the following:

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen. LPA observed gloves and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan. LPA observed PPE supplies at the facility.



Physical Plant/Planned activities: LPA observed the resident bedrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. No pools are present at the facility. Laundry room was observed to be locked and equipment was observed to be in working condition.

Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SILVERADO SENIOR LIVING-ESCONDIDO
FACILITY NUMBER: 374604255
VISIT DATE: 03/12/2024
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Care & Supervision/Administration: LPA observed adequate staff are present for the supervision of residents. Emergency exiting plans, personal rights, and ombudsmen were found posted in the facility. LPA reviewed the facility's liability insurance and found that it was current.

Record Review and Resident/Staff Files: LPA reviewed (5) staff files. All staff have updated training along with CPR/First Aid Certification. Five (5) resident files were reviewed, and found all required documents were present.

Health Related Services/ Incidental Medical Services: All resident medications were locked in a medication room with medication carts. LPA observed the facility has a first aid kit on the premises and had a sharps container for needles.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility last disaster drill on 2/16/2024, which met the department requirements. LPA observed all facility exits, and evacuation routes were posted at the facility. LPA observed the facility's emergency supplies along with disaster preparedness binder.

There were no regulation violations observed during today's visit. An exit interview was conducted where a copy of this report was reviewed and provided to Administrator In Training, Michael Zuletta.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
LIC809 (FAS) - (06/04)
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