306005922-2-16-2021-22-AS-MBAT-BYB3G7-20210216171353

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005922
Report Date: 02/16/2021
Date Signed: 02/16/2021 05:20:32 PM

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:	SILVER LINING RESIDENTIAL CARE		FACILITY NUMBER:	306005922
ADMINISTRATOR:	CAMACHO, JESSICA		FACILITY TYPE:	740
ADDRESS:	25455 EL PICADOR LANE		TELEPHONE:	(714) 745-5194
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 0	DATE:	02/16/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Applicant (AP) Jessica Camacho		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 10:00 AM, Licensing Program Analyst (LPA) Mike Barrett contacted the facility via FaceTime application, using iPhone technology, to commence a pre-licensing inspection due to COVID-19 and pre-cautionary measures. LPA identified himself and discussed the purpose of the announced video call and spoke with Applicant (AP) Jessica Camacho. The facility contains 4 bedrooms with 2 full bathrooms, is a single-story building with a 2-car garage. LPA Barrett's observations during the physical plant inspection were as follows: Physical Plant: At 10:10 AM, LPA conducted the virtual inspection with AP and toured the inside and outside of this facility including but not limited to the kitchen, common areas, laundry room, garage, bathrooms, bedrooms, back patio and walkways. LPA observed that the facility was clean, there were no obstructions to the interior or exterior walkways and the backyard gates were observed to be self-closing and self-latching. The kitchen was observed to be clean and all appliances were new and operational. The smoke detectors were equipped with carbon monoxide detectors, were installed throughout common and bedrooms and were centrally wired. They were tested and observed to be in good operation. LPA had AP test the alarms installed on all of the exit doors and they were observed to be functional. Fire extinguisher was located close to the front door and was observed to be appropriately charged and mounted. Centrally Stored medications were planned to be stored in the laundry room which will remain locked. Bedrooms: Bedrooms were observed to have made beds appropriate closet space, dresser drawers, appropriate lighting and exit doors were free of obstructions with operational alert system. Continued on page 2.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Michael Barrett	TELEPHONE: (714) 703-2847
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SILVER LINING RESIDENTIAL CARE	FACILITY NUMBER: 306005922
	VISIT DATE: 02/16/2021

NARRATIVE

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Continued from page 1.
Bathrooms:
Bathrooms were equipped with grab bars and non-skid mats in the shower stalls and the water temperatures
from the faucets measured within regulation 105 and 120 degrees F. Toilets and sinks were clean and in good operation.

Laundry:
The washer and dryer were located in the laundry room.

Food Service:
There were no residents in the facility at the time of this inspection. LPA and AD discussed the regulation
2-day perishable and 7 day non-perishable food to be kept on hand.

Records:
Staff and Resident files were planned to be stored in the locked office.

Administration:
LPA observed and reviewed the facility’s Emergency Disaster Plan, Resident Personal Rights and “Let-
Us-No” poster posted in the facility.

Activities:
LPA and AP discussed activities planned for the residents in the facility and LPA observed crafts, puzzles and
games for the residents.

Component III orientation:
The Component III Orientation conducted as well as a question/answer session for consultation.

Applicant stated that the facility does plan to advertise for dementia care. This inspection has been completed
and, based on the results of this inspection, this facility is recommended for licensure. An exit interview was
conducted with Applicant, Jessica Camacho, and a hard copy of this report was provided via email for Signatures

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Michael Barrett	TELEPHONE: (714) 703-2847
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021

LIC809 (FAS) - (06/04)

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