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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604502
Report Date: 03/04/2022
Date Signed: 03/07/2022 10:27:23 AM

Document Has Been Signed on 03/07/2022 10:27 AM - It Cannot Be Edited

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:EL AMOROSO HOME IVFACILITY NUMBER:
374604502
ADMINISTRATOR:BARNES, BOOTSFACILITY TYPE:
735
ADDRESS:11172 CALLE DARIOTELEPHONE:
(858) 265-6265
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 4CENSUS: 0DATE:
03/04/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Philip BarlisTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA), Natasha Persaud conducted an announced Pre-Licensing/Component III inspection. LPA identified herself and explained the purpose of the visit with Administrator, Philip Barlis and House Manager, Juna Barlis to ensure Title 22 compliance. An initial application was received by the Department on 09/15/2021. The Applicant/Licensee requested to be licensed for a capacity of four (4); Two (2) Ambulatory and Two (2) Non-Ambulatory Developmentally Disabled adults, ages 18-59.

Structure- The facility is a one story structure with 4 bedrooms, and 2 bathrooms. There is an outdoor covered area for client use. No bodies of water were observed. Per the Administrator, there are no firearms or weapons on the premises.
Bedrooms Clients- Rooms #1, #2, will be used for Ambulatory clients only. Rooms #3, #4, will be used for Non-Ambulatory clients only.
Bedrooms Staff- There are no staff rooms.
Bathrooms- All bathrooms have a working toilet, sink, and non-skid rugs.
Linens & Hygiene Supplies- Adequate supply.
Emergency Phone Numbers, Exit Plan and Required Postings- Posted.
Smoke Detectors and Carbon Monoxide Detectors- Operational.
Appliances- Stove burners, oven, microwave, washer, and dryer working.
Toxins- Stored in a locked cabinet..
Water Temperature- Measured at 107 degrees F.
Medications- Centrally stored and locked in a closet.
First-Aid Kit- Stored in a locked cabinet.
Client & Staff Files- Located in a locked cabinet. cabinet.
Activities- Adequate supplies.
Fire clearance- Approved on 12/09/2021.
Component III- Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2022
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: EL AMOROSO HOME IV
FACILITY NUMBER: 374604502
VISIT DATE: 03/04/2022
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All items reviewed during the visit are in compliance. Facility appears to be ready for licensure pending final review. Pre-Licensing is complete and this facility has no deficiencies.

An exit interview was conducted with, Administrator, Philip Barlis and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Administrator and Applicant/Licensee via electronic mail. An electronic read receipt confirmation was requested to be sent by the Applicant/Licensee upon receipt of the documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
LIC809 (FAS) - (06/04)
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