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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603919
Report Date: 10/09/2025
Date Signed: 10/09/2025 11:07:47 AM

Document Has Been Signed on 10/09/2025 11:07 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:AMABLE CAREFACILITY NUMBER:
198603919
ADMINISTRATOR/
DIRECTOR:		GONZALEZ, STEPHANIEFACILITY TYPE:
740
ADDRESS:7812 VIA AMORITATELEPHONE:
(949) 690-3546
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY: 6CENSUS: 0DATE:
10/09/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:36 AM
MET WITH:Stephanie Gonzalez - AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analysts (LPAs) Tena Herrera and Gabriela Castro conducted an announced pre-licensed visit and met with Licensee/Administrator Stephanie Gonzalez for the purpose of conducting a Pre-Licensing Inspection / Component III visit. The facility has an approved fire clearance to be licensed to serve 6 Adults ages 60 and over. The facility is a single story home: 3 bedrooms, 2 bathrooms, living room, dining area, kitchen with laundry area, office area, backyard, front yard and attached garage located in Downey, CA.

The physical plant was toured inside and out alongside Stephanie Gonzalez. Pre-Licensed Inspection Tool was used.


The following was observed/inspected
· Bedrooms are equipped with one bed, night-stand, chair, sufficient lighting, appropriate closet and drawer space.
· All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads.
· Bedrooms are large enough to allow for easy passage between and comfortable for usage of beds and other required items of furniture.
· Sufficient supply of linens available to permit weekly changing and are stored in storage cabinet.
· Sufficient personal hygiene supply available, laundry machine (wash/dryer) observed.
· The 2 bathrooms have working toilets/wash basin, and shower. Shower is missing non-slip mat. water temperature was within range
· Smoke Detectors and Carbon monoxide detectors are interconnected approved in the Fire Clearance.
· Two (2) Fire extinguishers observed and charged.
· Cleaning solutions and sharps are securely locked in kitchen and inaccessible to residents.
· Kitchen cabinets, refrigerator/freezer, oven, microwave, dishwasher are in working condition, clean and sanitary.
(Continued on 809-C)
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2025
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 3
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: AMABLE CARE
FACILITY NUMBER: 198603919
VISIT DATE: 10/09/2025
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· Food Menu Samples observed.
· Sufficient dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair.
· There is a designated space for Medications to be locked and inaccessible to residents.
· Client and Staff files will be stored electronically and Administrator showed LPAs how files will be stored
· First Aid Kit was observed with manual.
· Physical plant is in good repair and building and grounds are free from hazards, window screens are in good condition.
· There is a shaded area provided in the backyard to accommodate clients, no bodies of water observed.
· The residence is equipped with central air and heating, temperature remains at comfortable temp.
· Facility cell phone line operable, facility number: 562-291-0495
· Variety of activity supplies for clients observed.
· Liability Insurance has not yet been purchased but administrator confirmed they will purchase the insurance prior to admitting first resident.

Component III was also completed at the time of the visit and all required documents for Licensing were discussed. Facility has met the physical plant requirements/ inspection as required per California Code of Regulations Title 22 Division 6.


An exit interview was conducted, and a copy of this report has been furnished to the Applicants. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
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