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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610254
Report Date: 05/14/2025
Date Signed: 05/14/2025 05:18:44 PM

Document Has Been Signed on 05/14/2025 05:18 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:AMARE VILLAFACILITY NUMBER:
197610254
ADMINISTRATOR/
DIRECTOR:		LANDICHO, RENELYNFACILITY TYPE:
740
ADDRESS:2042 KALLIOPE AVENUETELEPHONE:
(661) 494-8008
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 6DATE:
05/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Renelyn LandicoTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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On 05/14/2023 at 1:20 p.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility listed above to conduct an unannounced annual inspection using the CARE Inspection Tool. LPA was greeted and granted access by staff #1 (S1). LPA observed appropriate postings upon entry. S1 contacted the the Administrator, Renelyn Landicho. LPA met with administrator shortly after. LPA explained the reason for the visit.

At 1:28 p.m., LPA Rios and the administrator conducted a physical plant tour of the facility inside and out and the following was observed:

Bedrooms: LPA inspected six (06) out of six (06) for resident bedroom. LPA observed each resident bedroom to be properly furnished and have sufficient lighting and storage.

Bathrooms: The facility has three (03) total bathrooms one (1) of which is located in the shared bedroom. LPA took hot water temperature from two (02) out three (03) bathrooms. At 1:49 p.m. the temperatures ranged from 107.8 and 107.4 degrees Fahrenheit, within regulation. LPA observed the bathrooms to be clean and properly supplied with toilet paper, paper towels, and hand soap. LPA observed a closet by the bedrooms with emergency food.

Laundry/Garage: Laundry room is kept locked and is a passageway to the garage. Detergents and cleaning chemicals are kept locked in the laundry room. LPA observed a washer and dryer and extra clean linens. Garage is not accessible to residents. In the garage LPA observed a second fridge with extra food stored for residents. By the laundry room LPA observed a fully stocked first aid kit and manual. (Cont. on LIC809-C)
NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2025
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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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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMARE VILLA
FACILITY NUMBER: 197610254
VISIT DATE: 05/14/2025
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(Continued LIC809-C) Living room: The living room was clean and properly furnished. There is a television and seating for the capacity of the facility. On two (02) sliding doors LPA observed mechanisms used to keep the doors locked when the sliding doors already have a lock on the door handle. Although the mechanism is able to open without a key the facility has has three (3) non ambulatory residents. The administrator removed both mechanism immediately.

Surrounding Grounds: There is a covered patio and appropriate furniture for residents to use. LPA observed a locked shed being used for storage. Side gate was checked to insure it was clear of obstruction. There are no bodies of water.

Kitchen/ Dinning area: The kitchen was observed to be clean and clear of clutter. Appliances and fixtures were functioning properly. LPA observed knives and sharps locked in drawer. LPA observed a sufficient amount of 2- day perishable and 7-day non-perishable food at the facility, properly stored. Dining area had appropriate table and chairs to sit the capacity of the facility.

Resident/Staff Records: From approximately 1:56 p.m. to 4:10 p.m. LPA reviewed six (06) out of (06) resident records and three (03) staff records. Records were observed complete, up-to-date and in compliance with licensing forms. LPA reviewed the facility's Infection Control Plan, Emergency Disaster Plan (LIC610E) and Liability Insurance, documents were reviewed by the administrator and up-to-date. Facility last conducted a Disaster Drill on 04/04/25 and a Fire Drill on 04/09/25. Medications are centrally stored and maintained locked in a designated cabinet located in the laundry room. Medications were observed locked. Centrally Stored Medication Records are filled in manually and facility keeps a Medication Administration Record (MAR).

LPA observed one (02) fire extinguishers fully charged one was last serviced on 08/15/2024 and the other was purchased on10/15/2024. At 4:25 p.m. LPA observed the administrator test a dual smoke and carbon monoxide detector. Detectors are hardwired and interconnected to other detectors located through out the facility. Detectors were observed to be functioning properly. There is a fire door leading to the bedrooms that automatically closed during the test.

Deficiency cited and cleared on todays visit. Exit interview conducted. Copy of report provided.
NAME OF LICENSING PROGRAM MANAGER: Eva Miller
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/14/2025 05:18 PM - It Cannot Be Edited


Created By: Evelin Rios On 05/14/2025 at 04:56 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: AMARE VILLA
FACILITY NUMBER: 197610254

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87307(d)(6)
Personal Accommodations and Services
(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in two (02) sliding doors having mechanisms used to keep the doors locked. Although the mechanism is able to open without a key the facility has three (03) non ambulatory residents which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/14/2025
Plan of Correction
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The administrator removed both mechanisms immediately. Citation cleared today.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Eva Miller
NAME OF LICENSING PROGRAM MANAGER:
Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2025


LIC809 (FAS) - (06/04)
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