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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000635
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:55:24 PM


Document Has Been Signed on 09/21/2022 03:55 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:CAMEO HOMES - MARINERSFACILITY NUMBER:
306000635
ADMINISTRATOR:ROSE MANABAT PALMAFACILITY TYPE:
740
ADDRESS:1411 MARINERS DRIVETELEPHONE:
(949) 515-8645
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY:6CENSUS: 5DATE:
09/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:51 PM
MET WITH:Erlinda VictorioTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregiver Erlinda Victorio and explained the reason for the visit. Administrator Rose Palma has an administrator certificate expiring on 11/18/2022. Administrator Rose Palma arrived during the visit.
At 1:10 PM, LPA toured the facility with Caregiver Leonardo. Facility has 5 residents present during today's visit with 3 on hospice. LPA observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms are currently single occupancy and had the required elements as well as restrooms stocked with soap/ sanitizer. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the entrance of the facility. Facility utilizes a visitor sign in sheet and documents temperatures and potential health symptoms. Facility has covid precaution postings as well as most required department postings. First aid kits have all required items. Smoke detectors tested operational and fire extinguishers are mounted and charged. Facility mitigation plan has been submitted and approved. LPA toured the outside grounds and observed multiple shaded outside visitation areas as well as a fenced and secured pool. Exit gates are unlocked and self latching. Facility has ample food supply. Residents participate in activities such as music and bingo. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed select resident files during the visit and all files are up to date including emergency information.
LPA consulted with Administrator Palma regarding the importance of maintaining an ample supply of emergency food on-site at all times.

Based on the observations made during today's visit, no deficiencies are being noted. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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