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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005770
Report Date: 01/29/2024
Date Signed: 01/29/2024 01:10:58 PM

Document Has Been Signed on 01/29/2024 01:10 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
ORANGE COUNTY ASC, 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: 3DATE:
01/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Direct Service Provider - George LozanoTIME COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. made an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by DSP George Lozano.

The facility is a one-story home with four bedrooms, two bathrooms, kitchen, dining room, living room, backyard and attached 1-car garage. Facility appears clean and sanitary. LPA noted clients were away at Day Program at the time of inspection. All residents rooms had required elements, including bed, chair, closet space and ample lighting. Facility had extra linens for clients in the hallway closet. Restrooms are stocked with soap and paper towels and have hand washing postings. Hot water measured at 110.9 degrees Fahrenheit. LPA observed facility has emergency food and water supply. DSP stated the fire extinguishers are scheduled to be serviced this week. LPA confirmed the service is scheduled via a phone call to Complete Fire Services at (714) 474-2935. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in drawers in the kitchen and the garage. Knives are locked up separate from toxic chemicals. Medication for each resident is kept locked in a closet in the hallway. The backyard has one shaded seating area. Exit gates are unlocked and self latching. LPA observed exit gates to be unobstructed. LPA reviewed all three client files. LPA also reviewed medication and P&I for all three clients. Facility has board games, exercise equipment, electronics and more for client use. Staff stated the clients are very independent and predominantly go out into the community on their own to engaged in preferred activities. Emergency contacts, Menu and Calendar are posted and available for review.

No deficiencies noted during today's inspection. An exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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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