430706162-8-23-2026-26-AS-MPAA-DX975J-20260823212138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430706162
Report Date: 08/06/2026
Date Signed: 08/23/2026 09:21:50 PM

Document Has Been Signed on 08/23/2026 09:21 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 HOME		FACILITY NUMBER:	430706162
ADMINISTRATOR/ DIRECTOR:	VALIN, AMOR & VIRGIL		FACILITY TYPE:	740
ADDRESS:	32 NORTH 21ST STREET		TELEPHONE:	(408) 971-4244
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95116
CAPACITY: 24		CENSUS: 22	DATE:	08/06/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	07:46 AM
MET WITH:	Amor & Virgil Valin		TIME VISIT/ INSPECTION COMPLETED:	12:45 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) Maria (Mita) Partoza conducted an unannounced Annual Required Inspection at the facility. LPA met with Licensee/Administrator (LIC/ADM) Amor and Virgil Valin and stated the purpose of the visit. The facility is licensed to serve residents age 60 and over. The facility has a licensed capacity of 24 residents. The facility is approved for 20 non-ambulatory residents. At the time of the visit, LPA observed 6 residents at the front of the facility with 2 staff supervision. Other residents were in their respective rooms. The facility has 4 building. Building #32 has no resident, the office is located at building #32. Building #34, has 5 bedroom 3 out of 5 are shared, 1 private bathroom and 1 hallway bathroom. Building #36 has 3 bedrooms that are shared, hallway bathroom and 1 private bathroom. Building #38 has 5 bedrooms, 3 out of 5 are shared, 1 private bathroom and 1 hallway bathroom. LPA inspected all resident rooms of each building and observed that each room has credenzas and closet, shared by residents to hold their personal belongings. The bathrooms have grab bars. The facility has two kitchen set up one in the dining area in building #36 and a separate kitchen for preparing meals and behind the kitchen is the pantry that holds 2 days of perishable food supply and 7 days of non-perishable food supply. The indoor temperature measured 70 degrees Fahrenheit and was within regulatory range. Hallways, passageways, and exits were observed without obstruction. Lighting was operational in the hallways and no obstruction or tripping hazard was observed, Each building has a side ramps and accessible for a person limited mobility. page 1 of 2

Romeo Manzano
Maria Partoza
	DATE: 08/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026

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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: AMOR RESIDENTIAL CARE HOME	FACILITY NUMBER: 430706162
	VISIT DATE: 08/06/2026

NARRATIVE

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LPA inspected the kitchen and food storage areas. Knives, sharp objects, cleaning supplies, chemicals, and other items that may pose a risk to residents were stored in locked areas and were inaccessible to residents. The kitchen water temperature measured 116.7 degrees Fahrenheit and was within regulatory range. Bathroom water temperatures measured between 116.7 degrees Fahrenheit and were within regulatory range.

Medications were centrally stored in a locked area and were inaccessible to residents. LPA inspected the first-aid kit and observed the required supplies. Cleaning supplies and laundry products were stored in locked areas. The washer and dryer were operational at the time of the visit.

Smoke alarms and carbon monoxide detectors were tested and produced an audible signal. The facility was equipped with a fire alarm system. The facility has a wall pull alarm system and fire extinguishers, which were last serviced on 02/23/2026 and 02/24/2026. Emergency exits were observed without obstruction.

LPA reviewed 6 resident records and 3 staff records. Resident records reviewed included admission agreements, physician’s reports, appraisal or needs and services plans, medication administration records, personal and incidental funds records, and other required documentation.

Staff records reviewed included criminal record clearances, health screenings, first-aid and cardiopulmonary resuscitation certifications, training records, and personnel documentation. Based on record review the staff had criminal record clearances and were associated with the facility. Staff training and certification records reviewed were current on the date of the visit.

The facility conducts fire and earthquake drills monthly for each shift. Records reviewed showed that the most recent drills were conducted on 07/14/2026.

No deficiencies were cited during today’s visit based on the California Code of Regulations, Title 22.
An exit interview was conducted with licensee/administrator (LIC/ADM) Amor and Virgil Valin. A copy of the report was reviewed and provided.

end of report

NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Maria Partoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026

LIC809 (FAS) - (06/04)

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