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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006244
Report Date: 09/04/2024
Date Signed: 09/04/2024 02:19:39 PM


Document Has Been Signed on 09/04/2024 02:19 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:AMORE SENIOR LIVINGFACILITY NUMBER:
306006244
ADMINISTRATOR:MARY DEE MOTTERFACILITY TYPE:
740
ADDRESS:25011 MONTE VERDE DRIVETELEPHONE:
(949) 503-1939
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 5DATE:
09/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Chet KhayTIME COMPLETED:
02:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a case management visit. The Department received a report that facility has been sold. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA and staff toured the facility. LPA observed the See Something, Say Something poster posted next to the front door. LPA observed the fireplace is sealed. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The fire extinguisher in the laundry room is fully charged. LPA observed the facility has electricity, gas, water and phone service. LPA interviewed staff and residents. No one interviewed had any knowledge of any change in ownership. LPA and staff toured the facility. LPA observed all the bathrooms are clean and operational. No obstacles or hazards observed inside or outside of the facility. No health and safety concerns observed during the visit. LPA called the Administrator and left a message to please contact the LPA. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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