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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005922
Report Date: 05/11/2022
Date Signed: 05/11/2022 10:55:20 AM


Document Has Been Signed on 05/11/2022 10:55 AM - 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: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: 0DATE:
05/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jessica Camacho TIME COMPLETED:
11:00 AM
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LPA Edward Tapia arrived at the facility to conduct a Case Management visit. LPA Tapia met Administrator Jessica Camacho and explained the purpose of the visit.

LPA Tapia received an email notification from Administrator Jessica Camacho on May 5, 2022 that she decided to close the facility. Administrator stated that her facility closed on May 3 2022. Administrator also stated on the email that all five residents in care were relocated to other licensed facilities. LPA Tapia gathered some additional information regarding the relocation dates of each residents and requested Administrator Jessica Camacho to surrender the facility license as part of the closure process.
LPA Tapia conducted the final walk through tour of the facility and observed no resident’s in care, items such as furniture, beds and household appliances were being packed and ready to be moved. LPA noticed no signs of operation. Administrator Jessica Camcho stated she decided to close the facility due to lack of staffing.

An exit interview was conducted, and LPA Tapia explained and provided the LIC809 report to Administrator Jessica Camacho.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward TapiaTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022
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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