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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850420
Report Date: 06/04/2025
Date Signed: 06/04/2025 06:49:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/30/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20250530125556
FACILITY NAME:AMYLEW MANOR 1 LLCFACILITY NUMBER:
565850420
ADMINISTRATOR:SORATORIO, AMALIAFACILITY TYPE:
735
ADDRESS:2006 SNOW AVE.TELEPHONE:
(805) 351-5198
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:6CENSUS: 4DATE:
06/04/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Janica Soratorio- Administrator AssistantTIME COMPLETED:
06:55 PM
ALLEGATION(S):
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Staff did not ensure a designated administrator was present at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez alongside Tri-Counties Regional Center Quality Assurance Specialist (QAS) Patrick Brown arrived at the facility unannounced to conduct an initial complaint investigation visit. Upon arrival the LPA and QAS met with staff at 1:20 pm and the reason for the visit was explained. Staff called Licensee representative Emmanuel Soratorio to advise of the visit, however they were unable to be present during the visit. Administrator assistant Janica Soratorio arrived shortly after.

During today's visit the LPA conducted interviews with Licensee representative Emmanuel, and one (1) staff telephonically, and in person interviews with Assistant Administrator, two (2) staff, sucesfully interviewed one (1) client, and attempted to interview two (2) other clients; reviewed staff schedule, conducted file review and obtained pertinent documents relevant to the investigation.

Report will continue on LIC9099-C, 2nd Page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 29-AS-20250530125556
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMYLEW MANOR 1 LLC
FACILITY NUMBER: 565850420
VISIT DATE: 06/04/2025
NARRATIVE
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Regarding the allegation, “Staff did not ensure a designated administrator was present at the facility”; the concern of the Reporting Party (RP) is that the Adult Residential Facility has been operating with no Administrator or Certified substitute in site as the Owner/Licensee (O1) has gone out of the country without legal coverage. Furthermore, it was reported that the Administrators/Licensees/owners only make appearances to the facility if notified of a visit. The Department has Amalia Soratorio as the administrator on file, however during today’s visit Administrator Amalia was not able to be present due to being out of the country since 05/28/25. Administrator did not notify the Department of the absence from the facility. Licensee representative Emmanuel Soratorio indicated that they are the current administrator of the facility and had submitted paperwork for a change of administrator to the Department via Fax around January, however, was not able to provide an exact date or the physical copy of the change of administrator packet submitted. In addition, Emmanuel was not able to be present during today’s visit and there was no Designation of Facility Responsibility form (LIC308) on file listing any individual as the Administrator’s designee. Based on the information obtained, the above allegation is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations (CCR), the following deficiency is cited (refer to LIC 9099-D). Exit interview was conducted and a copy of the report and Appeal Rights were issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250530125556
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMYLEW MANOR 1 LLC
FACILITY NUMBER: 565850420
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2025
Section Cited
CCR
85064(f)
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85064 Adminstrator Qualifications and Duties (f) When the administrator is absent from the facility there shall be coverage by a designated substitute,... who shall be.. responsible and accountable for, management and administration of the facility in compliance with applicable law....
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Assistant Administrator agrees to submit a Designation of Facility Responsibility form (LIC308) to the department with a designated substitute who be will at the facility when the Administrator is absent. They will also submit a change of Administrator notification with all the required documentation,
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This requirement is not met as evidence by: Based on interviews and file review, the Administrator has been out of the country since 5/28/25 and there is no designated substitute on file which poses a potential health, safety or personal rights risk to persons in care.
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Change of administrator and LIC308 will be submitted no later than 06/13/25.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/30/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20250530125556

FACILITY NAME:AMYLEW MANOR 1 LLCFACILITY NUMBER:
565850420
ADMINISTRATOR:SORATORIO, AMALIAFACILITY TYPE:
735
ADDRESS:2006 SNOW AVE.TELEPHONE:
(805) 351-5198
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:6CENSUS: 4DATE:
06/04/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Janica Soratorio- Administrator AssistantTIME COMPLETED:
06:55 PM
ALLEGATION(S):
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9
Facility has insufficient staff to meet the needs of residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez alonside Tri-Counties Regional Center Quality Assurance Specialist (QAS) Patrick Brown arrived at the facility unannounced to conduct an initial complaint investigation visit. Upon arrival the LPA and QAS met with staff at 1:20 pm and the reason for the visit was explained. Staff called Licensee representative Emmanuel Soratorio to advise of the visit, however they were unable to be present during the visit. Administrator assistant Janica Soratorio arrived shortly after.

During today's visit the LPA conducted interviews with Licensee representative Emmanuel, and one (1) staff telephonically, and in person interviews with Assistant Administrator, two (2) staff, sucesfully interviewed one (1) client, and attempted to interview two (2) other clients; reviewed staff schedule, conducted file review and obtained pertinent documents relevant to the investigation.

Report will continue on LIC9099-C, 2nd Page.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250530125556
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMYLEW MANOR 1 LLC
FACILITY NUMBER: 565850420
VISIT DATE: 06/04/2025
NARRATIVE
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Regarding the allegation, “Facility has insufficient staff to meet the needs of residents in care” the concern of the Reporting Party (RP) is that there is a shortage of staff for overnight shifts. Staff interviews and staff schedule indicated that during the night shift there is always one (1) awake staff, and the facility has three (3) different staff that work the overnight shift. Night shift staff revealed that one (1) staff is enough to meet the clients care needs during the night shift as the residents are sleeping, there is only four (4) clients, and the clients require minimal assistance. Staff further revealed that clients and their families have not voiced any concerns to them about their needs not being met. Successful interview with one (1) client revealed that their care needs are being met, whenever they have needed help at night staff has always been available and they have never observed the home without a staff present. Furthermore, Assistant Administrator Janica stated that they do not have any staffing issues at the home and if they ever did the administrators would be able to cover any shift necessary. Based on this information, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and report issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5