565850342-3-29-2023-29-AS-TCAA-CQDTH7-20230329144416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850342
Report Date: 03/29/2023
Date Signed: 03/29/2023 02:45:25 PM

Document Has Been Signed on 03/29/2023 02:45 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	AMYLEW MANOR 2		FACILITY NUMBER:	565850342
ADMINISTRATOR:	SORATORIO, EMMANUEL		FACILITY TYPE:	735
ADDRESS:	1138 MELITO DR		TELEPHONE:	(805) 890-0597
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY: 6		CENSUS: 0	DATE:	03/29/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Lew Soratorio		TIME COMPLETED:	11:30 AM

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) Teresa Camara conducted a pre-licensing visit to the above noted facility. The LPA met with applicant Lew Soratorio at Amylew Manor 2 (565801889) which is currently located at 1360 Holly Ave., Oxnard, CA 93036 and their census is 5. LPA completed a brief physical plant tour to observe the items that will be relocated to the new location at 1138 Melito Dr. Oxnard, CA 93030 once it is licensed. LPA and applicant then went to the new location. The facility is one-story. At 10:10 a.m. a physical plant tour was conducted inside and out. An approved fire clearance was received for six ambulatory residents. The fire extinguishers were located in the kitchen, living room and hall; they were purchased 3/15/2023 and all appeared fully charged. The smoke detectors and carbon monoxide detector all functioned properly during the visit. The facility has two (2) double-occupancy resident bedrooms (bedrooms 1 and 4) and two (2) single occupancy resident bedrooms (bedrooms 2 and 3). Bedrooms do not have exits to outside. There is no staff room at the facility, therefore the facility must have 24/7 awake staff. There are two bathrooms in the residence; one in the main bedroom (bedroom 1) and one in the hall. The hall bathroom has a shower/tub combo and the main bathroom has a step in shower. Both bathrooms have grab bars. The laundry room is located just outside the hall bathroom. The hot water temperature was tested and found to be within the range of 105F and 120F; with an average of 110.3*F. Resident records will be stored in a locked cabinet with the medications and first aid supplies in the family room. Staff records will be stored in a locked cabinet in the garage. (continued on 809-C)

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMYLEW MANOR 2	FACILITY NUMBER: 565850342
	VISIT DATE: 03/29/2023

NARRATIVE

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(continued from 809)

Kitchen knives and cleaning supplies will be stored in a locked cabinet under the kitchen sink. Other cleaning supplies will be stored in a locked cabinet in the garage. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 37*F. No flies or other vermin were observed.

The new facility will be furnished with items from the current facility which will be closed once they have moved. The licensee will hire a moving company to move the large pieces of furniture from their current location to the new facility. Facility staff will assist residents to ensure all of their personal properly is moved and unpacked in the new facility. The licensee will do the majority of the move while clients are at their day program.

There is sufficient space to accommodate both indoor and outdoor activities. There is a fireplace with a fireplace screen located in the family room. The physical plant is consistent with the submitted facility sketch/floor plan. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; they have central air conditioning which can cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility has a wi-fi telephone. The emergency exiting plans/sketch are posted near the front door and in each bedroom. The emergency telephone numbers are posted in the living room along with other required postings.

The exterior passageways were clean and clear of any obstructions. The side gates are self-latching. There are no bodies of water on the premise.

LPA conducted a Component III review with the applicant. The application is ready for completion. Exit interview conducted and report emailed to the applicant.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC809 (FAS) - (06/04)

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