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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850420
Report Date: 09/05/2024
Date Signed: 09/05/2024 01:52:03 PM

Document Has Been Signed on 09/05/2024 01:52 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:AMYLEW MANOR 1 LLCFACILITY NUMBER:
565850420
ADMINISTRATOR/
DIRECTOR:		SORATORIO, AMALIAFACILITY TYPE:
735
ADDRESS:2006 SNOW AVE.TELEPHONE:
(805) 351-5198
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY: 6CENSUS: 6DATE:
09/05/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Lew Soratorio/ Amalia SoratorioTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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At 10:15 a.m. Licensing Program Analyst (LPA) Esther Cortez conducted a pre-licensing visit to the above noted facility. The LPA met with applicants Lew B Soratorio Jr., Emmanuel Soratorio and Administrator Amalia Soratorio. This is a change of ownership application. Component III was completed during the inspection with the applicants.

The facility is one story. At 11:20 a.m., a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for a capacity of six (6); three (3) non-ambulatory clients and three (3) ambulatory clients. The facility has two (2) private client bedrooms, and two (2) shared room(s), Room #1, and #4 are to accommodate ambulatory clients, while #2 and #3 are to accommodate non-ambulatory clients. Client rooms #2 and #3 have direct exits to the outside. The facility does not have fire sprinklers. All client rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair.

There is one (1) common restroom in the hallway and one private restroom in bedroom #4. Both client bathrooms have showers with grab bars and non-skid materials. The hot water temperature in the was measured at 107.6* F in the client's communal bathroom which falls within the allowable range of 105*F to 120*F.

Report will continue LIC809-C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/05/2024
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Client and staff records are stored in a cabinet, which is currently located in the dinning area. Medications are centrally stored in a locked cabinet in the dinning area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a cabinet in the dinning area.

Kitchen knives are stored in a locked drawer in the kitchen. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of perishable and nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in the kitchen and a locked cabinet located in the garage. No flies or other vermin were observed.

The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, magazines and/or activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to non private bathrooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There is a fireplace in the living room, that is screened and there are no tools. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and a central A/C to cool the rooms so that they do not exceed 85 degrees Fahrenheit.

The facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There are two (2) fire extinguishers in the house, fully charged and recently serviced on 08/25/2024.The laundry area is located in the garage.

Report will conitinue on LIC809-C (3rd page)..
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMYLEW MANOR 1 LLC
FACILITY NUMBER: 565850420
VISIT DATE: 09/05/2024
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The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in the garage. Extra incontinence supplies are stored in the garage. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted on the wall of the entryway. The emergency telephone numbers are posted on the wall of the entryway. Other required postings are posted on the wall of the entryway.

The exterior passageways were clean and clear of any obstructions. There is a canopy covered patio area at the back of the house with chairs and a small table. The back and sides of the house are separated from the front yard by gates at the north and south side passageways. There is no front yard gate or driveway gate. There are gates with a self-latching mechanism for persons to enter the back yard on both sides of the house. There are no bodies of water on the premises at the present time. The garage is accessible from the house; the doors were unlocked from the inside of the house. Toxic or danger items or tools in the garage, were locked in a cabinet during the visit.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
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