374603535-5-15-2026-08-AS-AGOH-DU4VP8-20260515163619

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603535
Report Date: 05/15/2026
Date Signed: 05/15/2026 04:36:33 PM

Document Has Been Signed on 05/15/2026 04:36 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 II		FACILITY NUMBER:	374603535
ADMINISTRATOR/ DIRECTOR:	BOOTS BARNES		FACILITY TYPE:	735
ADDRESS:	6854 MEWALL DRIVE		TELEPHONE:	(619) 713-0274
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92119
CAPACITY: 4		CENSUS: 4	DATE:	05/15/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:50 PM
MET WITH:	Caregivers Janet Johnson and Liza Sevilla		TIME VISIT/ INSPECTION COMPLETED:	04:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Janet Johnson. The facility's license shows a maximum capacity of four (4) developmentally disabled adults aged eighteen (18) through fifty-nine (59), all of whom must be ambulatory. During today’s inspection there were four (4) clients in care, however one (1) was currently at the hospital. LPA and Caregiver Johnson toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Common bathroom sink was 107.9F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to clients in care. [Continued on LIC 809-C]

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Arian Golbakhsh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: EL AMOROSO HOME II	FACILITY NUMBER: 374603535
	VISIT DATE: 05/15/2026

NARRATIVE

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[Continued from LIC 809]

When touring the garage area, LPA was shown the two (2) storage cabinets where chemical and cleaning items were stored. One cabinet was locked and the other was not as the latch the lock was placed on was broken, leaving the cabinet and it's contents accessible to clients. Staff immediately moved the chemical items and placed them in another locked storage area. As staff had been supervising clients the entire time LPA had been present at the facility, no immediate risk was present and a Type B deficiency was issued for the accessible chemicals. Additional details about the deficiency are included on the LIC 809-D page.

Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per caregiver Johnson, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. The fire extinguisher was purchased within the last 12 months, dated for October 2025. Last staff emergency drill conducted was on 2/18/26 for the topic of fire. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA and caregiver Johnson reviewed client's Personal & Incidental (P&I) monies and ledgers and physical cash present matched.

LPA reviewed facility records and confidential items were stored in locked areas. As LPA was reviewing staff files, LPA noted that a staff member (identified as S1) was not associated to the facility. Additionally, during the visit, another individual (identified as S2) transported two (2) clients back to the facility from day program. S2 was not on the staff association roster and per staff interview, S2 worked at a sister facility location and was filling in today for this facility's usual driver. Review of the Guardian background check system revealed both S1 and S2 had eligble background clearances, but were not associated to this facility. One Type A deficiency was issued for having staff working at a facility without having their background clearance associated to the facility. In addition, a Civil Penalty was assessed for the total of $600.00 and details are included on the attached LIC 421BG.

LPA interviewed one (1) staff and one (1) client, and interviews did not reveal any additional licensing or regulatory concerns. Two (2) deficiencies were cited during the inspection. An exit interview was conducted with Caregiver Johnson to whom a copy of this report, the LIC 421BG, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Arian Golbakhsh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/15/2026 04:36 PM - It Cannot Be Edited

Created By: Arian Golbakhsh On 05/15/2026 at 03:37 PM

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 II	FACILITY NUMBER: 374603535
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80019(e)(3)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 80019(f) or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA file review and interview, the licensee did not comply with the section cited above in ensuring that all staff were associated to the facility prior to working at/being present at the facility, which poses an immediate health, safety or personal rights risk to all persons in care.
	POC Due Date: 05/16/2026
	Plan of Correction
1 2 3 4	LPA informed Licensee that S1 and S2 could not be present at or work at the facility until they are associated to the facility. Licensee will associate S1 and S2 to the facility and submit proof to LPA by POC due date or submit LIC 9182 forms to CCL for S1 and S2 by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:

	Arian Golbakhsh
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/15/2026 04:36 PM - It Cannot Be Edited

Created By: Arian Golbakhsh On 05/15/2026 at 03:37 PM

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 II	FACILITY NUMBER: 374603535
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(g)

Building and Grounds

(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, the licensee did not comply with the section cited above in ensuring toxic items and chemicals were stored in locked/secured areas inaccessible to clients, which posed a potential health and safety risk to all persons in care.
	POC Due Date: 05/22/2026
	Plan of Correction
1 2 3 4	Staff immediately moved the chemical items to a secured storage area. Licensee will conduct review/training with staff on proper storage procedures and submit proof to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:

	Arian Golbakhsh
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

LIC809 (FAS) - (06/04)

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