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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609345
Report Date: 09/01/2026
Date Signed: 09/01/2026 03:49:30 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/01/2026 03:49 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: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:
09/01/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Melissa Gile - CaregiverTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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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, Melissa Gile. LPA contacted the administrator Rita Morales and explained the purpose of the visit. Rita could not meet LPA but was available by telephone. Due to technical issues the Inspection Tool was not used for this visit.

The facility is licensed as a Residential Care Facility for the Elderly (RCFE) and has an approved fire clearance for six (6) non-ambulatory residents and a Hospice waiver of four (4). At 1:00 p.m., LPA initiated a physical plant tour of the facility and the following was observed:

Kitchen: The kitchen was observed clean and clear of clutter. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility. The fire extinguisher is located in the kitchen and was observed fully charged with service date 04/16/2026.

Bedrooms: There are a total of four (4) resident bedrooms, two (2) of which are shared. Bedrooms were furnished with beds, night stands, chairs, appropriate bedding and linens, and sufficient lighting. LPA observed full length bed rails on five (5) resident beds. According to the administrator Resident #6 (R6) in room #4 is not on Hospice but the facility is utilizing bed rails to prevent falls.

Bathrooms: There are two (2) bathrooms designated for resident use. One (1) is located in a shared bedroom. Bathrooms were properly supplied with hand soap, toilet paper and paper towels. Hot water temperature was taken from both bathroom at 1:30 p.m. and read 127.6 and 128.3 degrees Fahrenheit. LPA observed night lights in the hallway leading to the common bathroom. (Continue on LIC809-C)
Mary G Flores
Evelin Rios
DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2026
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CASA AMORE
FACILITY NUMBER: 197609345
VISIT DATE: 09/01/2026
NARRATIVE
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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 and were observed in good repair.
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. Auditory alarms leading to the outside where on and functional during visit.

Resident Files: LPA conducted a file review of five (5) of six (6) resident records to insure compliance of licensing forms at at approximately 1:56 p.m. One (1), Resident #5's R5's record was not available for LPA to review. A Medical Assessment was not on file for R6. According to administrator the records should be in the facility. Staff was unable to locate R5's file or R6's medical assessment. Six (6) records did not have current medical annual visits documented. Resident #4 (R4) did not have a signed admission agreement from resident or their responsible person.

Facility Files: LPA was not provided a record for staff currently working in the facility. LPA requested to review the facilities certification of liability insurance, emergency disaster plan and emergency drills. According to the administrator she is unsure if the liability insurance has been renewed and stated the facility has not conducted emergency drills but will discuss with staff what to do incase of an emergency.

Medications: Medication and medication records were observed locked in the closet inaccessible to residents in care.

The smoke alarms are hard wired and interconnected. A carbon monoxide detectors was observed in the hallway by the bedrooms. Smoke and carbon monoxide detector were tested at 3:37 p.m. and were observed to be functioning properly.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were observed during the visit (refer to LIC809-D). Exit Interview Conducted. Appeal Rights provided. A copy of the report to caregiver.
NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Evelin Rios
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/01/2026 03:49 PM - It Cannot Be Edited


Created By: Evelin Rios On 09/01/2026 at 02:10 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: CASA AMORE
FACILITY NUMBER: 197609345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/02/2026
Section Cited
CCR
87303(e)(2)

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(e) Water supplies and plumbing fixtures shall be maintained as follows:(2)... not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
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Administrator will lower water temperature and send the department a picture when complete to the department by POC due 09/02/26.
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Based on observation, the licensee did not comply with the section cited above in two (2) out of two (2) bathrooms had a temperature reading higher than 120 degrees which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
09/11/2026
Section Cited
HSC1569.605

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...all residential care facilities for the elderly, ..., shall maintain liability insurance ...in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate,... This requirement is not met as evidenced by:
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Administrator will email a valid certification of liability insurance to the Department by POC due date 9/11/26.
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Based on record review, the licensee did not comply with the section cited above LPA was not provided a copy INS at time of visit which poses/posed a potential 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.
Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:
Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/01/2026 03:49 PM - It Cannot Be Edited


Created By: Evelin Rios On 09/01/2026 at 02:27 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: CASA AMORE
FACILITY NUMBER: 197609345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2026
Section Cited
CCR
87412(a)

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(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
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Administrator will send completed file to the Department by POC due date 09/11/26.
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Based on record review, the licensee did not comply with the section cited above in one (1) staff file notprovided to LPA at time of visit which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
09/17/2026
Section Cited
CCR87463(h)(1)

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(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months,... (1) Documentation of the annual routine visit, ..., shall be added to the resident's record.
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Updated LIC 602s will be sent to the Department by POC due date 09/17/2026
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 This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above as 6 residents did not have current medical exams LIC 602 on file which poses/posed a potential 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.
Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:
Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/01/2026 03:49 PM - It Cannot Be Edited


Created By: Evelin Rios On 09/01/2026 at 02:37 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: CASA AMORE
FACILITY NUMBER: 197609345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2026
Section Cited
HSC
1569.695(c)

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(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. ... This requirement is not met as evidenced by:
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Administrator will send documetaiton of drill conducted to the Department by POC due date 09/11/26.
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Based on record review, the licensee did not comply with the section cited above facility did not have drill at time of visit which poses/posed a potential health, safety or personal rights risk to persons in care. This requirement is not met as evidenced by:
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Type B
09/11/2026
Section Cited
CCR87506(a)

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(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
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Administrator will send R3's file to the Department by POC due date 09/11/26.
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Based on record review, the licensee did not comply with the section cited above facility did not R5's record available for review during visit which poses/posed a potential 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.
Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:
Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/01/2026 03:49 PM - It Cannot Be Edited


Created By: Evelin Rios On 09/01/2026 at 02:44 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: CASA AMORE
FACILITY NUMBER: 197609345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/02/2026
Section Cited
CCR
87608(5)(B)

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(5) ... (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by:
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Administrator will remove bedrail and send a picture when complete to the department by POC due 09/02/26.
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Based on observation, the licensee did not comply with the section cited above in one resident that is not receiving Hospice services has a full length bed rail which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
09/11/2026
Section Cited
CCR87507

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(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any,... This requirement is not met as evidenced by:
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Administrator will send a copy of admission agreement to the department by POC due 09/11/26.
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Based on record review, the licensee did not comply with the section cited above in not having a signed admission agreement for R4 which poses/posed a potential 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.
Mary G Flores
NAME OF LICENSING PROGRAM MANAGER:
Evelin Rios
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2026


LIC809 (FAS) - (06/04)
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