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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700208
Report Date: 03/05/2024
Date Signed: 03/05/2024 03:35:57 PM


Document Has Been Signed on 03/05/2024 03:35 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:AMORUSO CARE HOMEFACILITY NUMBER:
342700208
ADMINISTRATOR:CHIRA, TITIANAFACILITY TYPE:
740
ADDRESS:8967 AMORUSO AVENUETELEPHONE:
(916) 475-7261
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 5DATE:
03/05/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Daniela Barbarosie, House ManagerTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility to conduct a health and safety check and follow-up with the status of the facility closure.

During today's inspection, LPA observed and interviewed resident (R1). LPA also discussed the status of the facility closure with House Manager.

No deficiencies are being cited as a result of today's visit. Exit interview was conducted with House Manager. A copy of this report was provided at the conclusion of the visit. Signature on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
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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