Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Camino Hills of San Clemente. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 bedridden residents. Facility has an approved hospice waiver for 6 residents and the home currently has 5 residents with 5 on hospice. Administrators Mercy Ang and Maria Cecelia Domingo arrived during the visit. Administrator Maria Cecelia Domingo has a current administrator certificate expiring on 07/11/2026.

LPA Lyman along with Administrator Ang toured the facility at 9:00 AM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. Facility appears to be clean, safe, and sanitary. The home consists of five resident bedrooms, one common restroom, one resident restroom, living room, dining room, staff room and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident rooms are single and double occupancy. Resident restrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 108.3 and 109.1 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the elements including thermometer, tweezers and scissors. LPA observed toxins are secured during today's visit. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and carbon monoxide detectors tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gate is unlocked and operational. LPA observed ample emergency food and water supply. LPA reviewed the emergency