Amen Senior Home

Type of visit: Required - 1 Year

On 2/04/2026 at approximately 4:10 p.m., Licensing Program Analyst (LPA), Evelin Rios conducted an annual visit to the facility. LPA met with the Administrator and explained the reason for the visit. The facility has not accepted any residents. LPA conducted a physical plant tour at approximately 4:10 p.m., and the following was observed: The facility is a single unit building with (4) bedrooms and two (2) bathrooms. There is no designated staff room. A fire clearance was approved on 06/26/2024, for six (6) non-ambulatory residents for a total capacity of six (6). Common areas: The living room and dining room were observed to be properly furnished and in good repair. LPA observed a fire extinguisher in the kitchen and living room to be fully charged with service date 02/07/2025. LPA observed required postings located throughout the common areas. A working telephone was observed accessible to residents. Kitchen: The kitchen was observed clean and clear of clutter. LPA observed a sufficient supply of seven (7) day nonperishable foods and two (2) day perishable foods. The knives/sharps are kept locked in a kitchen drawer. Bedrooms: The residents' bedrooms are adequately furnished with appropriate furniture and storage space. The passageways and hallways were observed free of obstructions. LPA observed extra linens in a hallway cabinet leading towards the bedrooms. (continued on LIC 809-C) Smoke detectors and carbon monoxide: LPA observed the smoke detectors and carbon monoxide to be working properly and were tested by the administrator at 4:35 p.m. Bathrooms: The bathrooms were clean and supplied with hand soap, paper towels and toilet paper. The bathroom was observed with grab bars and non slip mats in the showers. The hot water delivered in the bathroom was measured at 4:55 p.m. and read between 118 and 119 degrees. Laundry Room: The laundry room is accessible to residents. Detergents and cleaning supplies are locked in the cabinet. Medications will be kept in a locked cabinet in the laundry room. Garage: The garage can be accessed from inside of the facility. LPA observed the garage is accessible from the laundry room. In the garage LPA observed the facility's emergency food. Backyard: The backyard of the facility has a patio that offers a shaded area for residents. LPA observed appropriate outdoor furniture. There is no body of water. Administrator has an active administrator certificate and first aid CPR is up to date. License fee is paid. No deficiencies observed. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 4, 2026

Type of visit: Prelicensing

At 9:15 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted a Pre-Licensing Inspection with the administrator, Denise Martin. This is new application for a Residential Care Facility for Elderly (RCFE). A fire clearance was approved on 06/26/2024, for six (6) non-ambulatory residents for a total capacity of six (6). A tour of the physical plant was initiated at approximately 09:25 a.m. and the following was observed: COMMON AREAS: These included living room and a dining room. The living room was equipped with furniture, a television, couches. There is a fireplace secured with a screen in the living room. The dining area has a dining room table to accommodate six (6) residents, a sofa and a piano. There were no visible immediate hazards. The facility has hard wired and battery operated smoke detectors through out the facility. At 9:38 a.m., smoke alarms and carbon monoxide detectors were tested and observed operational. OFFICE: There is an office space located in the living room. Resident and staff records will be maintained locked in a filing cabinet. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, gas stove, microwave, and dishwasher. There is an adequate supply of seven (7) days nonperishable food. There is an adequate amount of table ware for the capacity of the facility. Knives and other sharps will be locked in a kitchen cabinet. Cleaning products and Chemicals are kept locked under the kitchen sink, inaccessible to residents in care. The fire extinguisher was located by the kitchen and in the living room. BEDROOMS: The facility has four (4) bedrooms. The applicant furnished all clients' bedrooms with beds, night stands, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. (Continue on LIC809-C) LAUNDRY ROOM/GARAGE: The washer and dryer is located in the laundry room accessible to residents. LPA observed all chemicals are kept locked in cabinets above the washer and dryer. The garage is accessible to from the laundry room. The garage is used for storage of the emergency food, water and facility supplies. BATHROOMS: The facility has two (2) bathrooms and were observed to have the proper fixtures, grab bars, non-skid mats, and trash cans with closed lids. The hot water delivered in the bathroom was measured at 1:10 p.m. to be at 119.2 degrees, within regulation. MEDICATIONS: The medications be centrally stored in on of the laundry room cabinet locked, inaccessible to residents. Facility has a First-aid kit and current manual. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home were clear of obstruction. The backyard of the facility is properly fenced, has a covered patio and backyard furniture to accommodate six (6) residents. There is no body of water. In addition to the Pre-Licensing inspection, a Component III power point presentation was also conducted with the administrator/applicant representative. Pre-Licensing is complete and this facility has no deficiencies. This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the 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. Exit interview conducted and copy of this report signed and delivered to the Administrator.the state’s words, verbatim · CDSS document, Nov 20, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Interview Method: Telephone interview On 10/25/2024, applicant/administrator participated in COMP II. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 25, 2024