<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604252
Report Date: 03/05/2025
Date Signed: 03/05/2025 01:15:32 PM

Document Has Been Signed on 03/05/2025 01:15 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:AMBROSIO HOME CAREFACILITY NUMBER:
374604252
ADMINISTRATOR/
DIRECTOR:		TORRES, ERNESTINAFACILITY TYPE:
735
ADDRESS:4579 JAMBOREE STREETTELEPHONE:
(442) 266-2952
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 3CENSUS: 2DATE:
03/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Administrator Ernestina TorresTIME VISIT/
INSPECTION COMPLETED:
01:20 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) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Ernestina Torres.

During today's visit, LPA toured the facility, reviewed facility records, and observed clients in care. During the tour of the facility kitchen, LPA observed cabinets with locks and were designated for sharp objects and cleaning chemicals that were unlocked. LPA also observed a blender blade that was stored in an unlocked kitchen cabinet. Administrator locked the cabinets in the kitchen and relocated the blender blade to locked storage. LPA also observed unlocked cleaning chemicals located in the facility garage and under the sink in the downstairs common bathroom. Administrator relocated unsecured cleaning chemicals to locked storage areas during the visit.

The following deficiency was cited for dangerous items being unsecured and noted on the attached LIC809-D page. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed.

An exit interview was conducted with Administrator Ernestina Torres, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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 2
Document Has Been Signed on 03/05/2025 01:15 PM - It Cannot Be Edited


Created By: Rebecca A Borunda On 03/05/2025 at 12:48 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: AMBROSIO HOME CARE
FACILITY NUMBER: 374604252

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(g)
80087 Buildings 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 observation, the licensee did not comply with the section cited above in that the cabinets for sharp objects were not kept locked and that cleaning chemicals were stored in unsecured areas of the facility, such as under the sink or in an unlocked area of the garage which poses a potential safety risk to 2 of 2 clients in care.
POC Due Date: 03/31/2025
Plan of Correction
1
2
3
4
Administrator will be creating a flyer on the fridge and signs on the locked cabinets in the kitchen to remind staff to keep the knife and cleaning chemical cabinets locked. Administrator stated that all staff, including the Administrator, will receive vendor training regarding storage of dangerous items and cleaning chemicals. Administrator will submit copies of training certificates and photos of the signs to the Department by POC due date of 3/31/2025.
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.
SUPERVISOR'S NAME:Jennifer Lott
LICENSING EVALUATOR NAME:Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2