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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005770
Report Date: 03/15/2022
Date Signed: 03/15/2022 09:21:25 AM

Document Has Been Signed on 03/15/2022 09:21 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CASA AMOROSA/LA REINAFACILITY NUMBER:
306005770
ADMINISTRATOR:ROJAS, NADINEFACILITY TYPE:
735
ADDRESS:509 N LA REINA STTELEPHONE:
(714) 723-0264
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 4CENSUS: 4DATE:
03/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Nadine RojasTIME COMPLETED:
09:37 AM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was greeted and granted entry. LPA met with Administrator Nadine Rojas. LPA explained the reason for the visit. LPA and Administrator toured the facility. The facility is a single story home with 4 bedrooms, 2 bathrooms, living room, kitchen and a 2 car garage. LPA observed that all of the bedrooms had the required furnishings. LPA observed Covid-19 postings throughout the facility. Smoke detectors/carbon monoxide detectors tested operational. LPA observed the knives and cleaning supplies are kept locked under the sink. LPA observed a 2 day perishable and 7 day non-perishable food supply on hand. LPA observed medication is kept locked in a closet. The first aid kit had all the required elements. The garage is used for storage and kept locked. No obstacles or hazards observed in the facility. The backyard has a covered patio with a table and chairs. The storage shed is used for storage. No bodies of water observed. Both exit gates are operational. No obstacles or hazards observed in the backyard. Facility has a mitigation plan that is pending review. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2022
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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