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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005922
Report Date: 02/01/2021
Date Signed: 02/01/2021 11:59:09 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS 8-3-91
SACRAMENTO, CA 95814
FACILITY NAME:SILVER LINING RESIDENTIAL CAREFACILITY NUMBER:
306005922
ADMINISTRATOR:CAMACHO, JESSICAFACILITY TYPE:
740
ADDRESS:25455 EL PICADOR LANETELEPHONE:
(714) 745-5194
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: DATE:
02/01/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jesseca
Camacho		TIME COMPLETED:
11:58 AM
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Facility Type: RCFE
Application Type: Initial
Capacity: 6
Census (if any clients in care): n/a
COMP II Participants: Jesseca Camacho/Licensee/Administrator
Interview Method: Telephone interview

On 2/1/21, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. Applicant and/or administrator did not provide sufficient knowledge the program and the California Code Title 22 Regulations. Component II will be rescheduled. Signed LIC 809 with copy of photo ID have been obtained.
SUPERVISOR'S NAME: Julia KimTELEPHONE: (916) 651-7848
LICENSING EVALUATOR NAME: Darla NeeleyTELEPHONE: (916) 651-7817
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021
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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