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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000734
Report Date: 04/12/2022
Date Signed: 04/12/2022 03:49:23 PM


Document Has Been Signed on 04/12/2022 03:49 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 - LIGHTHOUSEFACILITY NUMBER:
306000734
ADMINISTRATOR:LISE BRICKFACILITY TYPE:
740
ADDRESS:2512 LIGHTHOUSE LANETELEPHONE:
(949) 644-2740
CITY:CORONA DEL MARSTATE: CAZIP CODE:
92625
CAPACITY:6CENSUS: 5DATE:
04/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Max Limliman and Lise BrickTIME COMPLETED:
03:00 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 Max Limliman and explained the reason for the visit. Licensee/ Administrator Lise Brick arrived during the visit. Administrator Lise Brick has an administrator certificate expiring on 08/04/2023.

At 1:15 PM, LPA toured the facility with Caregiver Tess Toledo. Facility has five residents in care during today's visit with two on hospice care. LPA observed residents relaxing in the facility. All residents appeared well taken care of. Facility appears clean and sanitary. All resident's rooms had the required elements as well as restrooms stocked with soap/ sanitizer. Hand washing signs are posted in the restrooms. LPA observed the screening station in the entrance of the facility. Facility has covid precaution postings as well as all required department postings. LPA toured the kitchen and observed ample food supply. Facility has completed the mitigation plan and plan has been approved. LPA observed emergency food and water as well as the first aid kit which contained all required items. LPA toured the outside grounds and observed the outside visitation area. Exit gate is unlocked and self latching. Residents participate in activities such as exercise and games. LPA observed the locked medication storage area. Facility has ample supple of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation. All staff and residents are vaccinated for Covid-19. LPA reviewed all resident files which contained all required documentation including emergency information.
LPA consulted with Administrator regarding the importance of taking staff and resident temperatures daily and documenting.

No deficiencies noted during today's visit. 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: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2022
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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