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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610344
Report Date: 01/21/2025
Date Signed: 01/21/2025 11:01:56 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/21/2025 11:01 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:AMEN HOMESFACILITY NUMBER:
197610344
ADMINISTRATOR/
DIRECTOR:		AYOARIYO, GEORGEFACILITY TYPE:
735
ADDRESS:3611 TOPAZ LNTELEPHONE:
(310) 753-3777
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: DATE:
01/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:George AyoariyoTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Lorena Casillas met Administrator George Ayoariyo for an unannounced one (1) year required visit for this facility.

LPA arrived at 09:30 am and was greeted by George Ayoariyo. LPA informed the Back Up Administrator of the purpose of the visit and an entrance interview was conducted.

A tour of the physical plant was conducted with the Administrator at 09:45 am. This is a 2-story home that has five (5) bedrooms and three (3) bathrooms currently unoccupied. Four (4) bedrooms are for client use and one (1) bedroom will be used as an office. One (1) bedroom is located on the first floor and will be used for a client. Four (4) bedrooms are located on the second floor to include the office. The facility is Fire Cleared for four (4) ambulatory clients.

The facility does not currently have any clients, Inspection Tool Kit will not be used for this visit.

Infection control: LPA Casillas reviewed Infection Control Plan submitted with program plan on 12/01/2022 to make sure licensee was following current infection control recommendations.

Food Inspection: LPA conducted a tour of the kitchen at 09:50 am and observed there to be sufficient stock seven-day non-perishable foods. Perishable and frozen foods will be purchased when there are clients in the facility. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and sharp objects locked in a hallway closet. Medication will be stored in a locked cabinet located in a hallway closet and are inaccessible to clients in care. There is one (1) fire extinguisher located in the kitchen. The fire extinguisher was observed full and last serviced on 01/20/2025.

Continued on LIC809-C.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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 2
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: AMEN HOMES
FACILITY NUMBER: 197610344
VISIT DATE: 01/21/2025
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Client Rooms: LPA observed rooms to have the appropriate bedding. There is a nightstand, chair, and sufficient lighting for each resident.

Bathrooms: At 10:00 am LPA observed all bathrooms to have the appropriated wash your hands signs posted. Hot water was tested at 10:00 am and measured within regulation at 117.3° F.

Laundry: At 10:10 am, LPA observed chemicals/hazardous items in a locked cabinet in the laundry room. The laundry room is located on the second floor.

Physical environment: LPA toured the outside area of the facility at 10:15 am. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. No bodies of water on the premises.

Living and dining: LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 70°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 10:20 am.

Garage: At 10:25 am, LPA observed the garage to be attached to the facility and currently being used to store extra water.

Administrative: Annual fee is current. Bond and current Administrator Certificate will be emailed to LPA. All required signs are posted.

An exit interview was conducted, and a copy of this report was given to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
LIC809 (FAS) - (06/04)
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