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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430706162
Report Date: 08/31/2022
Date Signed: 08/31/2022 02:32:29 PM


Document Has Been Signed on 08/31/2022 02:32 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:AMOR RESIDENTIAL CARE HOMEFACILITY NUMBER:
430706162
ADMINISTRATOR:VALIN, AMOR & VIRGILFACILITY TYPE:
740
ADDRESS:32 NORTH 21ST STREETTELEPHONE:
(408) 971-4244
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:24CENSUS: 22DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Virgil ValinTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 year visit and met with Virgil Valin, Administrator.

During visit, LPA Marrufo toured the inside and outside of the facility. LPA Marrufo observed there to be a visitor screening area at the entrance. LPA Marrufo observed a PPE supply of at least 30 days, a perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days.

LPA Marrufo observed the outdoor exit to be clear of obstructions.

No deficiencies were cited as per California Code of Regulations Title 22.

This report was reviewed with Amor and Virgil Valin and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: David MarrufoTELEPHONE: (650) 380-0519
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022
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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