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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336427425
Report Date: 06/18/2024
Date Signed: 06/18/2024 04:21:53 PM


Document Has Been Signed on 06/18/2024 04:21 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:AMRO ELDERLY CARE HOMEFACILITY NUMBER:
336427425
ADMINISTRATOR:GRAVILONI, DANIELAFACILITY TYPE:
740
ADDRESS:10213 CALIFORNIA AVETELEPHONE:
(951) 785-1869
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:6CENSUS: 0DATE:
06/18/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Daniela Graviloni - LicenseeTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Sara Martinez conducted an announced visit to the facility. The inspection is in response to the licensee initiating closure of the facility. LPA met with Licensee Daniela Graviloni, who was informed of the purpose of the visit.

LPA conducted a final inspection and walk through of the home. LPA observed the bedrooms, bathrooms, garage, front and back yard of the home. All residents were relocated and LPA verified relocation with responsible parties. LPA observed there are no residents in care at the time of the visit. The licensee no longer wishes to hold a license with the department. During the visit, the physical license was obtained by the LPA.

An exit interview was conducted with the Licensee Graviloni where this report was reviewed and provided to them. LPA will send a final closure letter to the licensee’s mailing address which was confirmed during the time of the visit.

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024
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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