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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610207
Report Date: 09/10/2024
Date Signed: 09/10/2024 04:01:00 PM

Document Has Been Signed on 09/10/2024 04:01 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:AMORE VILLAFACILITY NUMBER:
197610207
ADMINISTRATOR/
DIRECTOR:		MELKONYAN, MARIYAFACILITY TYPE:
740
ADDRESS:8455 SPRINGFORD DRTELEPHONE:
(818) 425-4975
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 6CENSUS: 1DATE:
09/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Mariya Melkonyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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This Case Management visit is conducted in conjunction with complaint investigation visit today. (Complaint 31-AS-20240903145023). The purpose of this Case Management visit is to address the deficiencies that were observed during the complaint investigation not related to the complaint. LPA de la Cerra was greeted by the staff #1 (S1) who identified herself as a caregiver for the facility. LPA explained the reason for the visit and requested the caregiver to inform the administrator about the visit. S1 provided their name and LPA de la Cerra noted that S1 did not have a criminal record clearance and association to the facility.
By allowing an individual who had no criminal record clearance and/or association to the facility, to be present and work for the facility.The licensee is in violation of CCR 87355(f)(1).
Therefore, the deficiency will be cited under Title 22, Division 6, Chapter 8, and will be recorded on LIC809D. In addition a civil penalty of (the amount) will be issued.
No other immediate health and safety hazard is noted during this visit.
Exit interview was conducted, appeal rights discussed.
The report was signed by the administrator, and copy of report was provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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Document Has Been Signed on 09/10/2024 04:01 PM - It Cannot Be Edited


Created By: Leizl De La Cerra On 09/10/2024 at 02:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMORE VILLA
FACILITY NUMBER: 197610207

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/11/2024
Section Cited
CCR
87355(f)(1)

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Criminal Clearance (f) Violation of Sec. 87355(e) shall result in an immediate... civil penalties(1)Subsequent violations within a twelve (12) mo. period will result in a civil penalty ($100)a day for a max of thirty 30 days.This requirement is not met as evidenced by
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LPA requested admin to remove S1 from facility asap. Within 24 hours licensee must inform RO that S1 is removed and will not return to facility without criminal record clearance & association.
Licensee will submit S1's fingerprints and associate the staff to the facility. Copy of proof will be submitted to LPA within 24 hours.
Civil penalty assessed.
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Based on interview and record review, the licensee did not comply with the section cited above by hiring one (1) staff member on without fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Naira Margaryan
LICENSING EVALUATOR NAME:Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


LIC809 (FAS) - (06/04)
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