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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006480
Report Date: 08/23/2024
Date Signed: 08/23/2024 10:50:53 AM

Document Has Been Signed on 08/23/2024 10:50 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:AMARI HOUSEFACILITY NUMBER:
306006480
ADMINISTRATOR/
DIRECTOR:
MOSHARRAF, MUSHAIRAFACILITY TYPE:
740
ADDRESS:515 N HARCOURT STTELEPHONE:
(562) 377-4764
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 6CENSUS: DATE:
08/23/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Mushaira MosharrafTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On August 23, 2024, 9:00am Licensing Program Analyst (LPA) Edward Kim conducted an announced Pre-Licensing continuation visit. LPA Kim was allowed entry and met with Applicant Mushaira Mosharraf. The purpose of today's visit was to follow-up on the issues that were present during the initial Pre-Licensing visit on August 13, 2024.

The applicant requested to have a capacity of six (6), of which six (6) can be nonambulatory and of which one (1) may be bedridden. The facility is a one story house with an attached 2 car garage with four (4) bedrooms (1 is for staff), 2 bathrooms, dining room, a kitchen, and a living room.

During a tour of the facility, LPA Kim observed that the following items have been corrected:

1) Backyard is clean and in good repair with the oranges removed. The facility will maintain weekly maintenance services to keep the backyard clean.


2) Left side gate door is operational by opening and closing.
3) The brick pathway has been replaced and is now stable.
4) Water temperature in the resident bathroom measured at 112.6 degrees Fahrenheit.
5) The facility has a tablet for the residents to use for internet access and for video conferencing purpose.

All items have been corrected. The facility is ready for licensure.

The pre-licensing visit and Component III Orientation are now complete. It appears this facility meets the requirements for licensure. LPA Kim will forward this report to the Centralized Applications Bureau for review. The license will be granted upon completion of a final review and approval from the Centralized Applications Bureau.



An exit interview was conducted and a copy of this report was provided to applicant Mushaira Mosharraf
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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