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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006843
Report Date: 03/16/2026
Date Signed: 03/16/2026 10:37:11 AM

Document Has Been Signed on 03/16/2026 10:37 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CAMINO RETIREMENT LIVING LLCFACILITY NUMBER:
306006843
ADMINISTRATOR/
DIRECTOR:		TATARICI, FLORELA GABRIELAFACILITY TYPE:
740
ADDRESS:18902 CAMINO VERDETELEPHONE:
(949) 394-5764
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 6CENSUS: 0DATE:
03/16/2026
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Applicant- Florela Gabriela TatariciTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On March 16, 2026, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA Kim met with Applicant Florela Gabriela Tatarici and toured the facility.

An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to CCL on February 23, 2025. The facility has a capacity of five (5) residents, of which five (5) can be nonambulatory and one (1) may be bedridden. Facility phone number (657-708-9261). LPA Kim observed the following.

Structure:
The facility is a one-story house with an attached two car garage and a four car garage with five (5) resident bedrooms, one (1) staff bedroom, family bedroom, four (4) bathrooms, dining area, family area, a kitchen, and a living area. The four car garage next to a storage area needs to be locked because there are power tools in it. Applicant stated they will add a lock to that door. There is a storage area next to the family ownership bedroom. There are six (6) exits: one exit door next to the living area, one in the main entrance, two exits in the family office area, one exit in the resident hallway, one exit in the family applicant bathroom, one in bedroom #1 which is the bedridden room, and one exit in bedroom #5.
Resident Bedrooms:
There are five (5) Resident Bedrooms: Bedroom #1, Bedroom #2, Bedroom #3, Bedroom #4, and Bedroom #5. The bedrooms are spacious and will easily accommodate the residents' belongings. All resident rooms had the furnishings. The following resident rooms have hospital beds. Bedroom #1 has one hospital bed, Bedroom #3 has one hospital bed, Bedroom#4 has one hospital bed, and Bedroom #5 has two hospital beds.
Evaluation Report Continues on LIC 809-C.
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CAMINO RETIREMENT LIVING LLC
FACILITY NUMBER: 306006843
VISIT DATE: 03/16/2026
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Staff Bedrooms:
There is one (1) Staff Bedroom. There is a family applicant bedroom next to the family office area.

Air/Heating:
Central air/heating system installed with a central panel to control entire house located in living area.

Bathrooms:
All bathrooms have a working toilet, wash basin and shower. All bathrooms are clean. Shower mats were in all bathrooms. Hot water was measured in all bathrooms. Hot water measured between 113.5 degrees Fahrenheit to 114.0 degrees Fahrenheit.
Linens & Hygiene Supplies:
Adequate supply of linen stored in the facility.

Emergency Phone Numbers, Exit Plan & Menu:
Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed and posted in the resident hallway. Menus posted.

Food Service:
There are no residents living in the facility currently. There is a 2-day perishable food. There is 7-day non-perishable food supply on hand. The emergency food and emergency supplies are stored in the outdoor storage shed.
Smoke Detectors/Carbon Monoxide Detectors:
There are two (2) fire extinguishers. One is mounted on the wall in the kitchen and one mounted on the wall in the staff bedroom. The fire extinguisher in the kitchen is fully charged and was inspected on November 25, 2025. The applicant will send the receipt of the fire extinguisher mounted in the staff bedroom.

Outdoor/Yard:
There are two covered outdoor areas and it has enough furniture with a table and chairs in the backyard. There are two locked outdoor sheds in the backyard. One shed contains gardening supplies and feeding supplies for chickens. The other shed contains emergency supplies, emergency water, and Personal Protective Equipment (PPE).
Evaluation Report Continues on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CAMINO RETIREMENT LIVING LLC
FACILITY NUMBER: 306006843
VISIT DATE: 03/16/2026
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Toxins:
All cleaning supplies and chemicals are kept in the garage, closet near the entrance, and locked underneath the kitchen sink.

Medications, First-Aid Kit & Book:
The first aid kit and all medications are stored and locked in a closet next to the entrance.

Resident & Staff Files:
The Resident and Staff Records will be kept locked in a closet near the entrance.

Reading Material, Games, Equipment & Materials:
Crossword puzzles, board games, and reading material are stored in a cabinet in the family area. There is a large screen TV in the living room and each resident room. There is a piano in the family area.

Appliances:
There is one five (5) gas burner stove which lights unassisted, oven, microwave oven, a refrigerator in the kitchen, dishwasher, washer, and dryer. All appliances are clean and operational.
Fire clearance:
Fire Clearance approved by Orange County Fire Authority on October 14, 2025.
Component III:
This will be conducted on the subsequent Pre- Licensing visit.

During the pre-licensing inspection, LPA Kim observed the following items that must be corrected:
1) Hospital beds need to be replaced in bedroom #1, bedroom #3, bedroom #4, and bedroom #5.
2) Fire extinguisher receipt for the staff bedroom, or a new fire extinguisher with a receipt needs to be provided.
3) Need a lock on the four car garage door.

The applicant plans on making the necessary corrections and contacting LPA Kim to schedule a follow-up pre-licensing inspection.
Exit interview was conducted and a copy of this report was left with Applicant Florela Gabriela Tatarici
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026
LIC809 (FAS) - (06/04)
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