306005692-6-2-2022-22-AS-LADS-CGZUPY-20220805154616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005692
Report Date: 06/02/2022
Date Signed: 06/02/2022 01:23:49 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
07/13/2021 and conducted by Evaluator Albert Marin

COMPLAINT CONTROL NUMBER: 22-AS-20210713153033

FACILITY NAME:	SILVERADO SENIOR LIVING-TUSTIN HACIENDA		FACILITY NUMBER:	306005692
ADMINISTRATOR:	MUELLER, ADRIENNE		FACILITY TYPE:	740
ADDRESS:	240 E 3RD STREET		TELEPHONE:	(714) 832-7900
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	42	CENSUS: 24	DATE:	06/02/2022
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Administrator Dwight Dunagan		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff spoke to resident in an inappropriate tone.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Albert Marin and Celine De Perio made an unannounced visit to this facility. LPAs met with Administrator (AD) Dwight Dunagan and stated the purpose of this visit.

On allegation that staff spoke to resident in an inappropriate tone, it was reported that On July 12, 2021 Resident 1 (R1) sought assistance from staff member. Staff 1 came in to assist the resident but during the interaction, Staff spoke to R1 in an inappropriate tone. Based on file review and interviews, LPA determined that Staff 1 did not use any foul or demeaning comments towards the resident. LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

LPAs Marin and De Perio conducted an exit interview with AD Dunagan; and copy of this report was left in the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

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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