Inspection Reports for Silverado Tustin Hacienda Memory Care Community
CA, 92780
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, including the most recent annual inspection on February 24, 2025, which was clean. One minor issue was noted in June 2022 when a staff member’s Basic Life Support certification had expired and First-Aid documentation was missing, but no citation was issued. Several complaint investigations were conducted, and all were unsubstantiated or found no deficiencies, even when incidents like resident altercations or falls occurred. The facility has maintained compliance with safety, medication, and environmental standards throughout the reports. Overall, the record shows consistent adherence to regulations with isolated, minor documentation issues that have not recurred.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
0.2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
95% better than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
55% occupied
Based on a February 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Annual Inspection
Census: 23
Capacity: 42
Deficiencies: 0
Feb 24, 2025
Visit Reason
An unannounced annual inspection was conducted by Licensing Program Analyst Andrea Mendivil to evaluate the facility's compliance with regulatory requirements.
Findings
The inspection included a tour of the facility, review of physical plant conditions, medication administration records, resident and staff files, and emergency preparedness. No deficiencies were cited during this visit.
Report Facts
Hot water temperature range: 106.7
Hot water temperature range: 112.6
Fire/carbon monoxide testing date: Mar 29, 2024
Fire drill date: Jan 16, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Benjamin Velasquez | Administrator | Met during inspection and exit interview |
| Breanna Creekmore | Director of Health Services | Met during inspection and exit interview |
Inspection Report
Annual Inspection
Census: 29
Capacity: 42
Deficiencies: 0
Aug 23, 2024
Visit Reason
Licensing Program Analyst Rose Ruppert conducted an unannounced annual required evaluation visit to the facility on 08/23/2024.
Findings
The facility was found to be in compliance with Title 22 Division 6 of the California Code of Regulations with no deficiencies cited. All safety equipment and procedures were inspected and found operational, and medication administration was reviewed and compliant.
Report Facts
Fire extinguisher service date: Mar 25, 2024
Last fire drill date: Jul 11, 2024
Hot water temperature range (Fahrenheit): Measured between 110.6 and 117.8 degrees Fahrenheit in five resident bathrooms.
Administrator certificate expiration: Jul 17, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sheila Fike | Administrator | Met with Licensing Program Analyst during inspection and participated in exit interview. |
| Benjamin Velasquez | Administrator-in-Training | Met with Licensing Program Analyst during inspection and participated in exit interview. |
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the unannounced annual inspection visit. |
Inspection Report
Census: 23
Capacity: 42
Deficiencies: 0
Sep 19, 2023
Visit Reason
An unannounced collateral visit was conducted by Licensing Program Analyst Andrea Mendivil to the Silverado Senior Living-Tustin Hacienda facility to perform case management and interview a resident.
Findings
No deficiencies were noted during the visit. An exit interview was conducted and a copy of the report was provided to the facility representative.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Erin Light | Executive Director | Greeted Licensing Program Analyst and was met with during the visit. |
| Andrea Mendivil | Licensing Program Analyst | Conducted the unannounced collateral visit and interview. |
| Alisa Ortiz | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 32
Capacity: 42
Deficiencies: 0
Sep 22, 2022
Visit Reason
The visit was an unannounced case management follow-up on an incident report dated 09/20/2022 involving an altercation between two residents.
Findings
The investigation found that two residents with dementia had an altercation resulting in no injuries. Both residents were assessed and transferred to hospitals for further care. No deficiencies were noted during the visit.
Complaint Details
The visit was triggered by a complaint incident report involving Resident 1 and Resident 2. The incident was investigated and found substantiated with no injuries. Both residents were diagnosed with dementia and appropriate actions were taken.
Report Facts
Incident date: Sep 18, 2022
Incident report date: Sep 20, 2022
Visit start time: 1350
Visit end time: 1520
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Malinda Smith | Charge Nurse | Interviewed regarding resident altercation |
| Erin Light | Senior Administrator | Present during visit and involved in incident follow-up |
| Andrea Mendivil | Licensing Program Analyst | Conducted the unannounced case management visit |
| Alisa Ortiz | Licensing Program Manager | Named in report header |
Inspection Report
Census: 25
Capacity: 42
Deficiencies: 0
Jul 13, 2022
Visit Reason
Licensing Program Analyst Albert Marin made an unannounced visit to conduct a case management evaluation of the facility.
Findings
No deficiencies were noted during the visit and no citations were issued. The analyst toured the facility, observed residents engaged in activities, conducted interviews and file reviews, and completed an exit interview with the administrator.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Marin | Licensing Program Analyst | Conducted the unannounced visit and exit interview. |
| Dwight Dunagan | Administrator | Met with Licensing Program Analyst during the visit. |
Inspection Report
Census: 24
Capacity: 42
Deficiencies: 1
Jun 2, 2022
Visit Reason
An unannounced case management visit was conducted to review facility compliance and staff certifications.
Findings
During the visit, it was observed that one staff member had an expired Basic Life Support (BLS) certification and lacked First-Aid certification documentation. No citation was issued.
Deficiencies (1)
| Description |
|---|
| Staff member had expired Basic Life Support (BLS) certification and missing First-Aid certification. |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dwight Dunagan | Administrator | Met during the visit and discussed certification issues. |
Inspection Report
Complaint Investigation
Census: 24
Capacity: 42
Deficiencies: 0
Jun 2, 2022
Visit Reason
An unannounced complaint investigation visit was conducted following complaints alleging that a resident sustained multiple falls while in care and that staff did not respond timely to a resident's alerts.
Findings
The investigation found that although the allegations may have happened or are valid, there was not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, both allegations were deemed unsubstantiated.
Complaint Details
The complaint involved two allegations: 1) Resident sustained multiple falls while in care, and 2) Staff did not respond timely to a resident's alerts. Both allegations were investigated and found unsubstantiated due to insufficient evidence.
Report Facts
Facility capacity: 42
Census: 24
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Marin | Licensing Program Analyst | Conducted the complaint investigation |
| Celine De Perio | Licensing Program Analyst | Conducted the complaint investigation |
| Dwight Dunagan | Administrator | Met with investigators during the visit |
Inspection Report
Complaint Investigation
Census: 24
Capacity: 42
Deficiencies: 0
Jun 2, 2022
Visit Reason
The visit was an unannounced complaint investigation triggered by a complaint received on 2021-07-13 regarding staff speaking to a resident in an inappropriate tone.
Findings
The investigation found that Staff 1 did not use any foul or demeaning comments towards the resident. The allegation could not be substantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that staff spoke to a resident in an inappropriate tone. The allegation was deemed unsubstantiated as the evidence did not prove or refute the claim.
Report Facts
Capacity: 42
Census: 24
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Marin | Evaluator / Licensing Program Analyst | Conducted the complaint investigation |
| Celine De Perio | Licensing Program Analyst | Assisted in conducting the complaint investigation |
| Dwight Dunagan | Administrator | Facility administrator met during the investigation |
Inspection Report
Complaint Investigation
Census: 24
Capacity: 42
Deficiencies: 0
Jun 2, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on January 5, 2022, regarding allegations that facility staff failed to provide requested resident information in a timely manner and mismanaged a resident's medication.
Findings
The investigation found insufficient evidence to substantiate the allegations. Both allegations—failure to provide requested resident information timely and mismanagement of resident's medication—were deemed unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint involved two allegations: 1) Facility staff failed to provide requested resident information in a timely manner; 2) Facility staff mismanaged a resident's medication. Both allegations were investigated and found unsubstantiated.
Report Facts
Facility capacity: 42
Census: 24
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Marin | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Celine De Perio | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Dwight Dunagan | Administrator | Met with investigators during the inspection |
Inspection Report
Complaint Investigation
Census: 26
Capacity: 42
Deficiencies: 0
Apr 28, 2022
Visit Reason
An unannounced case management visit was conducted to follow up on an incident report dated 04/19/2022 regarding an un-witnessed fall of a resident on 04/15/2022.
Findings
No deficiencies were noted during the visit. The incident involved a resident who had a fall and was subsequently placed on hospice care with visits twice a week and as needed.
Complaint Details
The visit was triggered by a complaint related to an incident report of a resident's un-witnessed fall on 04/15/2022. The resident was assessed, had an x-ray, and was placed on hospice care. No deficiencies were found during the investigation.
Report Facts
Facility capacity: 42
Census: 26
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dwight Dunagan | Administrator | Met during the visit and involved in the incident follow-up |
| Ashley Guerra | Director of Health | Met during the visit and involved in the incident follow-up |
| Melinda Smith | LVN | Found the resident on the floor after the fall |
Inspection Report
Annual Inspection
Census: 25
Capacity: 42
Deficiencies: 0
Feb 17, 2022
Visit Reason
Licensing Program Analyst Albert Marin conducted an unannounced required annual inspection of the facility to assess compliance with regulations.
Findings
The facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. The inspection included review of the physical environment, safety systems, food stock, medication storage, and COVID-19 mitigation plan.
Report Facts
Licensed capacity: 42
Current census: 25
Hospice waiver capacity: 18
Residents under hospice care: 1
Private rooms: 18
Shared rooms: 31
Hot water temperature range: 110
Hot water temperature range: 115
Date of last smoke alarm and sprinkler inspection: Sep 2, 2021
Date of Dietitian Report: Feb 16, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Albert Marin | Licensing Program Analyst | Conducted the inspection and exit interview |
| Dwight Dunagan | Administrator | Facility administrator met with Licensing Program Analyst during inspection |
Inspection Report
Original Licensing
Census: 26
Capacity: 42
Deficiencies: 0
Feb 4, 2021
Visit Reason
An announced Pre-Licensing visit was conducted via phone FaceTime virtual technology due to the Coronavirus Pandemic and precautionary measures for an initial application to operate a Residential Care Facility for the Elderly (RCFE).
Findings
The facility was toured and inspected including physical plant, food service, resident rooms, bathrooms, and safety features. All areas were found to be in good condition with no hazards, adequate supplies, and operational safety equipment. The facility is ready to be licensed.
Report Facts
Capacity: 42
Census: 26
Fire drill date: Jan 14, 2021
Quarterly drill date: Nov 23, 2020
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Adrienne Mueller | Administrator | Facility Administrator present during inspection |
| James August | Licensing Program Analyst | Conducted the pre-licensing inspection |
| Sheila Santos | Licensing Program Manager | Named in report header |
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