197610254-4-19-2024-31-AS-TSMH-D4GU79-20240419151935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610254
Report Date: 04/19/2024
Date Signed: 04/19/2024 03:19:42 PM

Document Has Been Signed on 04/19/2024 03:19 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	AMARE VILLA		FACILITY NUMBER:	197610254
ADMINISTRATOR:	LANDICHO, RENELYN		FACILITY TYPE:	740
ADDRESS:	2042 KALLIOPE AVENUE		TELEPHONE:	(661) 878-5085
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	6	CENSUS: 5	DATE:	04/19/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Renelyn Landicho		TIME COMPLETED:	03:25 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Tihesha Smith conducted an unannounced 1-year visit to this facility. LPA Smith was greeted by the administrator.

LPA conducted a tour at 11:15 am of the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

LPA Smith inspected the common areas. This included the living room, dining areas, s. All common areas were observed well lit, clean and free of clutter. Furniture appeared clean, in good repair and adequate seating for residents.

The kitchen food supply was observed and sufficient for the five (5) residents. Two (2) days of perishable fruits, vegetables, drinks observed. The kitchen was observed to be sanitary. The sharps are locked in kitchen island drawer and observed to be inaccessible. There is an additional refrigerator with food replenishment in the garage.

The medication is stored in laundry room upper cabinets. The cabinets were observed to be locked and inaccessible to residents. First aid kits and PPEs stored in office area and observed to be stocked.

There are six (6) bedrooms in the home designated for residents’ use. All bedrooms were properly furnished and had sufficient lighting. There are two (2) bathrooms in home for residents’ use. Each bathroom has posted “wash your hands” signs and were clean, properly supplied and had functional fixtures. The hot water temperature for resident bathrooms as follows: Bathroom #1 at 107.9 Fahrenheit and bathroom #2 bathroom at 114.6 degrees.

The garage is locked and only accessible from the inside. The laundry room is located in throughway to the garage. Washer and dryer observed to be in good repair. The toxins are stored and locked in cabinets in laundry room. Toxins observed to be inaccessible to residents.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMARE VILLA	FACILITY NUMBER: 197610254
	VISIT DATE: 04/19/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Cont fron 809C)

Smoke alarms and carbon monoxide detectors were present and function properly at time of visit. There is one (1) fire extinguisher attached to kitchen wall near patio door and observed to charged.

The backyard has a covered patio area, including a two tables, and chairs observed with adequate seating.

LPA Smith reviewed facility operations book at approximately 10:45 am-11:15 am. Staff and resident files reviewed at approximately 1:15 pm -2:50 pm. Records observed to be complete files. Staff records have current First aid certificates on file. Resident record had admission agreements and physician's report on file.

No hazards are deficiencies observed at time of visit.

Exit interview conducted/Copy of report given

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2