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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336411959
Report Date: 03/21/2025
Date Signed: 03/21/2025 11:42:20 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/21/2025 11:42 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:AMBERHILL GUEST HOMEFACILITY NUMBER:
336411959
ADMINISTRATOR/
DIRECTOR:		MARIA C.G. VICTORIOFACILITY TYPE:
740
ADDRESS:12729 AMBERHILL AVETELEPHONE:
(909) 923-2110
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator Julita Rodriguez TIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Raquel Hernandez arrived to the facility to conduct an annual required visit. LPA met with Administrator Julita Rodriguez. LPA learned that the facility has not retained any residents at this time. Administrator Julita Rodriguez is in the process of retaining residents.

The facility is an Residential Care Facility for The Elderly. Licensed capacity is (6) current census (0). LPA was accompanied by Administrator Julita Rodriguez to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to future residents in care. There was a designated space for future resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for future residents in care.

Food Service: Facility has a variety of food available for future residents. Dishes, cups, and utensils were also stored properly.

Record Review: LPA observed a designated place for all future residents and staff files as well as for resident medications.

Efren MalagonTELEPHONE: (951) 202-6356
Raquel HernandezTELEPHONE: 951-248-0336
DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AMBERHILL GUEST HOME
FACILITY NUMBER: 336411959
VISIT DATE: 03/21/2025
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Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Julieta Rodriguez.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Raquel HernandezTELEPHONE: 951-248-0336
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC809 (FAS) - (06/04)
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