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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320675
Report Date: 07/20/2026
Date Signed: 07/20/2026 11:50:17 AM

Document Has Been Signed on 07/20/2026 11:50 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:NJ AMAZING CARING HOMEFACILITY NUMBER:
198320675
ADMINISTRATOR/
DIRECTOR:		REZAEE, NAJMEHFACILITY TYPE:
740
ADDRESS:32322 CONQUEROR DRIVETELEPHONE:
(818) 666-7776
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY: 6CENSUS: 0DATE:
07/20/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Najmeh Rezaee- Administrator TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 07/20/2026, Licensing Program Analyst (LPA) Bernadette Allen conducted an announced visit to conduct a pre-licensing inspection. LPA met with Najmeh Rezaee- Administrator of NJ Amazing Caring Home.

An application for fire safety inspection was submitted to Community Care Licensing Division (CCLD) on 4/24/2026 for the total capacity of 6 residents age range 60 and over. The clearance is approved for five (5) non-ambulatory in bedroom 1,2, and 3. There maybe one (1) bedridden in bedroom #2.


Physical Plant/Structure:

At 9:50 AM, The department toured the physical plant and the following was observed.
The facility is a (3) bedroom, (3) bathroom, single story home., living room, dining room, kitchen, laundry area, The backyard area has an outside shaded patio area. The department did not observe any bodies of water and property was free of debris/obstructions.

Bedrooms:
At 10:30 AM, The three (3) bedrooms were observed to have the following, beds which appeared to be in good condition with the required linens, appropriate lighting and lamps, nightstands, dressers, closet/storage area and chairs/couch.
Stephanie Cifuentes
Bernadette Allen
DATE: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2026
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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: NJ AMAZING CARING HOME
FACILITY NUMBER: 198320675
VISIT DATE: 07/20/2026
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Bathroom Structure:
The two (2) resident bathrooms were observed to have a working toilet, wash basin, and shower equipped with rails and a slip resistant mat. The bathrooms can accommodate non-ambulatory residents.

Water temperatures measured in each bathroom ranged between 105°F and 120°F. The staff bathroom is located in the laundry area.

Toxins:
The Department observed toxins, cleaning supplies, and knives stored locked under the kitchen sink and in the laundry area, making them inaccessible to residents.

Medications, First Aid Kit & First Aid Book:
At 11:00 AM, the Department observed a new first aid kit containing a thermometer, tweezers, scissors, antiseptic, bandages, gauze, and a current first aid manual.

Linens & Hygiene Supplies:
The Department observed additional linens and hygiene supplies stored and available for resident use.

Food Service:
The Department observed the facility kitchen to contain a five-day supply of perishable food items and a seven- day supply of non-perishable food items, all stored and maintained properly. Dishes, cups, and flatware were stored in the kitchen and appeared to be in good repair.

Smoke Detectors:
The Department observed the facility to have operational smoke detectors and carbon monoxide detectors. All devices were tested and found to be working and fire extinguishers were fully charged.

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Bernadette Allen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
LIC809 (FAS) - (06/04)
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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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: NJ AMAZING CARING HOME
FACILITY NUMBER: 198320675
VISIT DATE: 07/20/2026
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Appliances:
The facility has a working refrigerator, stove, oven, microwave, washer, and dryer. The residence is equipped with central air and heating.

Residents & Staff Files:
At the time of the pre-licensing inspection, there were no resident files available for review. The department did review the Administrators file which contained the required documentation which included, First Aid/CPR certification, criminal record clearance, training records, and health screenings.

Component III:
During the pre-licensing visit, between 9:35 PM and 12:00 PM, Component III orientation was provided to the licensee. Information was reviewed regarding how to operate the facility in substantial compliance with applicable regulations and is ready to be licensed.

Najmeh Rezaee also confirmed that the email address NRUSCO2025@YAHO0.COM is valid.

Based on the Department’s inspection of the facility, no deficiencies were cited.

An exit interview was conducted with Najmeh Rezaee and a copy of the report was provided at the conclusion of the visit.

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Bernadette Allen
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
LIC809 (FAS) - (06/04)
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