374604383-6-24-2021-08-AS-EHAN-C4AM5L-20210624091830

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604383
Report Date: 06/23/2021
Date Signed: 06/24/2021 09:19:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	AMARIAH HOME CARE		FACILITY NUMBER:	374604383
ADMINISTRATOR:	JR. ALVELA, JOSEPH P.		FACILITY TYPE:	740
ADDRESS:	1046 HELIX AVE		TELEPHONE:	(619) 731-1535
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91911
CAPACITY:	6	CENSUS: 2	DATE:	06/23/2021
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Licensee, Joseph Alvela Jr.		TIME COMPLETED:	04:23 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 Analysts (LPAs) Elizabeth Hamilton and Dang Nguyen and Licensing Program Manager (LPM) Denise Powell conducted an unannounced visit to conduct a post-licensing inspection to ensure that the facility is operating in compliance with California Code of Regulations, Title 22, Division 6. LPAs and LPM were granted entry into the facility by Licensee, Joseph Alvela Jr. and LPA Hamilton disclosed the purpose of the visit. A tour of the facility was conducted inside and out. LPAs and LPM, accompanied by Alvela, conducted a general overall inspection, which included, but was not limited to, the following: facility physical plant, food service, medication management, records review, and facility administration. During today's inspection, LPAs and LPM observed the following: All indoor and outdoor passageways were free from obstructions. The facility’s indoor temperature was 79 degrees Fahrenheit. No pools or bodies of water were observed. According to the Licensee there are no firearms or ammunition stored in the facility. Cleaning supplies and toxins were locked and inaccessible to the residents. LPAs and LPM toured resident bedrooms. The rooms had the required furnishings and sufficient lighting. A fireplace was observed, covered and non-operational. Licensee provided the residents with clean linens, in good repair, and sufficient hygiene products for personal use. The hot water temperature in resident bathroom #1 measured 107.2, bathroom #2 106.9 and bathroom #3 105.4 degrees Fahrenheit. The facility had functioning carbon monoxide detectors and smoke detectors that met statutory regulations.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: AMARIAH HOME CARE	FACILITY NUMBER: 374604383
	VISIT DATE: 06/23/2021

NARRATIVE

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The facility was stocked with a two (2) day supply of perishable and seven (7) day supply of nonperishable food items. Medications were stored in a locked cabinet and were labeled and maintained in compliance with label instructions. Staff present had criminal record clearance and current first aid certification on file. The resident files contained current records. Licensee does not currently secure resident cash resources. LPAs and LPM observed the required postings in a prominent place in the facility. Administrator Certification for Joseph Alvela Jr. expires June 17, 2022.

Based on today’s visit there were no deficiencies cited in the areas above. An exit interview was conducted with the Licensee and a copy of this report and Licensee/Appeal Rights (LIC9058 01/16) were provided to the Licensee via email. An electronic receipt of confirmation was requested to be sent by the Licensee upon receipt of the documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth Hamilton	TELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021

LIC809 (FAS) - (06/04)

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