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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609345
Report Date: 09/25/2024
Date Signed: 09/25/2024 03:55:50 PM

Document Has Been Signed on 09/25/2024 03:55 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CASA AMOREFACILITY NUMBER:
197609345
ADMINISTRATOR/
DIRECTOR:		MORALES, RITAFACILITY TYPE:
740
ADDRESS:44124 WESTRIDGE DRIVETELEPHONE:
(661) 289-0288
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 6DATE:
09/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:28 PM
MET WITH:Rita Morales via telephone / Caregiver Micaela OrozcoTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by caregiver Micaela Orozco. Micaela contacted the administrator Rita Morales. Rita could not meet LPA but was available by telephone. LPA contacted the Licensee Margarita Tortorici and informed them the reason for the visit. Licensee designated Micaela Orozco to sign todays report.

At 12:50 p.m. LPA conducted a physical plant tour inside and out and the following was observed:

LPA observed required postings in the entry area and observed the administrator certificate with expiration date 11/04/2022. LPA reviewed Community Care Licensing website and did see administrator's name on the active certificate list.

Kitchen: The kitchen appliances and fixtures appeared functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility; properly stored. LPA observed knives and sharps in a drawer inaccessible to residents. The fire extinguisher is located in the kitchen and was observed fully charged with service date 10/17/2023.

Bedrooms: There are a total of four (4) resident bedrooms. Two (2) of the bedrooms are shared. Bedrooms were properly furnished with appropriate bedding and linens and with sufficient lighting. A hallway closet by the bedroom was observed locked. LPA observed night lights in the hallway.

Bathrooms: There are two (2) bathrooms for resident use. One (1) is located in a share bedroom. Bathrooms were properly supplied with hand soap, toilet paper and paper towels. Hot water temperature was taken from one (1) bathroom at 1:35 p.m. and read between 105 and 120 degrees Fahrenheit.
(Continued on LIC809-C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CASA AMORE
FACILITY NUMBER: 197609345
VISIT DATE: 09/25/2024
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Common Areas: These included the living area and dining area. The common areas were properly furnished. The couches and the dining table sits the capacity of the facility.

The smoke alarms are hired wired and interconnected. A carbon monoxide detectors was observed in the hallway by the bedrooms. Smoke and carbon monoxide detector were tested at 3:25 p.m. and were observed to be functioning properly.

Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area was free of hazards and has a covered patio with outdoor furniture. The laundry room leads to the garage and is kept locked and inaccessible to residents in care. Detergents and cleaning products are kept in the laundry room and garage locked.

Resident Files: At approximately 1:43 p.m., LPA conducted a file review of six (6) out six (6) resident records to insure compliance of licensing forms. LPA discussed with Rita the importance of proper documentation. LPA emailed Rita a list of LIC forms. LPA also reminded Rita to submit an updated Dementia Program as the one previously submitted required more information.

Medications: Medication and Medication Records were reviewed for proper documentation. Medication is stored in a closet that is maintained locked. LPA observed a first aid kit and other facility supplies in the closet.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during todays visit. Exit Interview Conducted. A copy of the report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
LIC809 (FAS) - (06/04)
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