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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602900
Report Date: 09/23/2024
Date Signed: 09/23/2024 03:46:49 PM

Document Has Been Signed on 09/23/2024 03:46 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:EL AMOROSO HOME INCFACILITY NUMBER:
374602900
ADMINISTRATOR/
DIRECTOR:
BOOTS BARNESFACILITY TYPE:
735
ADDRESS:8447 HUDSON DRIVETELEPHONE:
(619) 303-6331
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY: 6CENSUS: 4DATE:
09/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Caregiver Sarah AlbanTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analysts (LPA) Iby Strong and Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs arrived at the facility but no one was present. Later, LPA's observed staff arrive and were welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Sarah Alban. According to the facility’s license, the facility has a maximum capacity of six clients, of whom 2 may be non-ambulatory.

LPAs toured the interior and exterior of the facility, and inspected each room. The facility was clean and sanitary. Two doors leading to the outdoors were observed without top door knob, leaving rooms subject to outdoor elements. Floor tile and walls in room 3 were observed to be incomplete. Pathway outdoors was observed to be obstructed with construction rock debris. One out of four client bedrooms did not contain a night stand, two of four client rooms were observed not to have chairs. Windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Two days of perishable food and seven days of non-perishable food was present. Some medications were observed to be locked though, during physical inspection LPAs observed a brown paper bag with numerous unstored medications next to dinning room

No pools or bodies of water on the premises. Per Sarah no firearms or ammunition are kept at the facility. Carbon monoxide detectors, and facility telephone were all working. There was no emergency lighting present. Fire extinguisher was present. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Fireplace was observed uncovered. Confidential records were stored in locked areas. Client record reviewed contained required documents. Staff records reviewed contained required documents.

Multiple deficiencies and one technical violation were issued on today's date. An exit interview was conducted with Sarah Alban with Administrator Juna Barlis present via telephone, to whom a copy of this report, LIC809 Dx3, LIC9102 and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document Has Been Signed on 09/23/2024 03:46 PM - It Cannot Be Edited


Created By: Iby Strong On 09/23/2024 at 11:04 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: EL AMOROSO HOME INC

FACILITY NUMBER: 374602900

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 09/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above in that floors were unfinished and doors leading to outdoor did not have knobs safety or personal rights risk to persons in care.
POC Due Date: 10/07/2024
Plan of Correction
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3
4
Licensee agrees to complete the floors and add a door knob to bedroom and garage door by POC date, pictures to LPA will be accepted.
Type B
Section Cited
CCR
80087(c)
Building and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations the licensee did not comply with the section cited above for all clients which poses a potential safety rights risk to persons in care.
POC Due Date: 10/07/2024
Plan of Correction
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Licensee agrees to fix outdoor paths by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Simon Jacob
LICENSING EVALUATOR NAME:Iby Strong
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/23/2024 03:46 PM - It Cannot Be Edited


Created By: Iby Strong On 09/23/2024 at 11:04 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: EL AMOROSO HOME INC

FACILITY NUMBER: 374602900

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 09/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(c)
Fixtures, Furniture, Equipment, and Supplies
(c) Fireplaces and open-faced heaters shall be inaccessible to clients to ensure protection of the clients' safety.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
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Based on observations, the licensee did not comply with the section cited above inall clients which poses a potential safety risk to persons in care.
POC Due Date: 10/07/2024
Plan of Correction
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Licensee agrees to add a fireplace cover by POC date.
Type B
Section Cited
CCR
85088(c)(2)
Fixtures, Furniture, Equipment, and Supplies
(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (2) Bedroom furniture including, in addition to (c)(1) above, for each client, a chair, a night stand, and a lamp or lights necessary for reading.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations the licensee did not comply with the section cited above in 2 of 4 clients in care which poses a personal rights risk to persons in care.
POC Due Date: 10/07/2024
Plan of Correction
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4
Licensee agrees to provide furnishings to cover regulations to client rooms by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Simon Jacob
LICENSING EVALUATOR NAME:Iby Strong
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/23/2024 03:46 PM - It Cannot Be Edited


Created By: Iby Strong On 09/23/2024 at 11:04 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: EL AMOROSO HOME INC

FACILITY NUMBER: 374602900

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 09/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85088(e)
Fixtures, Furniture, Equipment, and Supplies
(e) Emergency lighting, which shall include at a minimum working flashlights or other battery-powered lighting, shall be maintained and readily available in areas accessible to clients and staff.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and interview the licensee did not comply with the section cited above in all clients in carewhich poses/posed a potential safety risk to persons in care.
POC Due Date: 10/07/2024
Plan of Correction
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Licensee has provided proof of purchase of emergency lighting to LPA. POC cleared on the same date.
Type B
Section Cited
CCR
80075(k)(1)
Health-Related Services
(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observations the licensee did not comply with the section cited above in all clients in care which poses potential health and safety risk to persons in care.
POC Due Date: 10/07/2024
Plan of Correction
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4
Licensee agrees to complete training for self and staff regarding proper storage of medications by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Simon Jacob
LICENSING EVALUATOR NAME:Iby Strong
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024


LIC809 (FAS) - (06/04)
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