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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000635
Report Date: 11/05/2021
Date Signed: 11/05/2021 02:22:36 PM

Document Has Been Signed on 11/05/2021 02:22 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:
11/05/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Mary Ann SisonTIME COMPLETED:
02:35 PM
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Licensing Program Analysts (LPAs) Kimberly Lyman and Jerome Haley made an unannounced plan of correction visit to follow up on citations issued on 10/26/2021. LPAs were greeted and granted entry into the facility by Caregiver Mary Ann Sison and explained the reason for the visit.

At 2:10 PM, LPAs toured the facility and observed the following:

*Deficiency cited under Title 22 Regulation 87705(f)(2) pertaining to inaccessible items has been cleared. All noted items have been secured. Licensee has complied with the terms of the POC.

*Deficiency cited under Title 22 Regulation 87705(j) pertaining to auditory exit alarms has been cleared. Both alarms were tested to be operational during today's visit. Licensee has complied with the terms of the POC.

All items on advisory note issued on 10/26/2021 have been addressed.




Exit interview conducted and a copy of this letter was left at the facility along with clearance letter for cited items.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
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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