Amor Residential Care Home

Type of visit: Required - 1 Year

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 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 reportthe state’s words, verbatim · CDSS document, Aug 6, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Virgil and Amor Valin, Administrators. LPA announced the purpose of the visit. LPA observed 3 residents in front porch, 6 residents in courtyard watching tv and 5 in backyard sitting area and 5 staff. During visit, LPA toured the facilities building #32, #34, #36 and #38. LPA observed 1 staff at the gate of the facility monitoring the front gate entrance to the facility grounds. LPA toured 18 resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. ADM tested the smoke detector in the office and found the smoke detector to function properly when tested. LPA toured 6 resident bathrooms. Each bathroom had available soap and automatic dryer and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 105 to 119.0 F. LPA toured the dining area in building #36 and kitchen area used for resident dining. LPA observed a separate kitchen area used for cooking and a separate room for kitchen food storage and pantry. LPA observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinet for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. page 1 of 2 LPA toured the outside area and found the exits to be clear of obstructions. LPA observed courtyard with seating area and shade for resident to sit. Courtyard was observed clear of obstruction and maintained. LPA observed fire extinguisher was last serviced on 01/16/2025. The facility has a pull fire alarm serviced on 01/16/25. LPA reviewed Fire and Earthquake log. The facility conducted the disaster drill on 08/04/25 LPA reviewed resident records for 5 residents. LPA reviewed 4 staff records. ADM reviewed the centrally stored medication for 3 residents. No deficiency were cited as per California Code of Regulations Title 22. This report was reviewed with Amor and Virgil Valin, Administrators and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 18, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced case management visit for the incident that was reported on 10/23/2024 and investigation was initiated on 10/24/2024. LPA met Licensee/Administrator Amor Valin and Virgil Valin and stated the purpose of the visit is to amend the report that was delivered on 1/8/2025 based on additional information. On 10/24/2024, the Department conducted a case management visit to for the incident report received on 10/23/2024 regarding resident (R1) who left the facility without staff's knowledge. R1 was found the next day by law enforcement (10/24/2024). On 10/24/2024, the Department interviewed 3 staff (S1, S2 & S3). 3 Out of 3 staff stated on 10/23/2024 during lunch time, approximately noon, they observed R1 was present at the facility. Staff S2 stated during snack time which was served at 3:00pm observed that R1 was not present at the facility. Staff reported to ADM that R1 was missing and law enforcement was called as soon as R1 was confirmed to be missing from the facility. The facility staff searched within the 3 mile radius but was not able to locate R1. Based on staff interview, 3 Out of 3 staff, stated that R1 recently moved to the facility and will always go to the gate, wanting to leave. 3 Out of 3 staff stated that ADM have instructed all staff to watch over R1 because R1 is new and is not familiar with his/her current surroundings. 3 Out of 3 staff stated that there will always be a staff by the gate to watch over the residents who are coming and going through the gate. Continuation on LIC 9099-C, Page 1 of 3. Based on observation and interview with staff, the gate is equipped with a bell alarm system alerting staff when a person/individual opens the gate. 3 Out of 3 staff stated R1 appears to have a wandering behavior and does not communicate well in English. Staff stated that R1 likes to speak with his/her roommate who spoke the same language as himself/herself. Staff stated based on R1s assessment, R1 can leave the facility unassisted. Staff were instructed by ADM because of the fact that R1 was new and still adjusting to his/her new environment should be supervised and assisted until R1 adjust to the new environment. 3 Out of 3 staff stated R1 was recently admitted and been in the facility for less than a month. 3 Out of 3 staff stated that during the time of the incident 10/23/2024, around 2:00 p.m. ADM called for a staff meeting and most staff were present except for one. 2 out of 3 staff stated the door was closed because it was cold. 1 out of 3 stated that the door was open. 3 Out of 3 stated they did not see R1 leave because they were all facing towards the office. 3 Out of 3 staff stated, one staff was left behind to look after all the resident's coming and going while the meeting is in progress. 3 Out of 3 staff stated the meeting lasted for less than an 30 minutes. 3 Out of 3 staff stated they were alerted that a resident opened the gate because of the loud alarm when the gate opened, but did not see R1 leave. 3 Out of 3 stated it was another resident that they saw. 3 out of 3 staff stated that the window in the office is huge so they can see residents passing when the gate alarms. R1 was found on 10/24/2024 by law enforcement and R1 was brought to the hospital for assessment. R1 returned back to the facility at approximately 7:00 p.m. On 4/9/2025, the Department interviewed ADM who stated that new residents are supervised at the facility for the first month after admission. ADM stated the day of 10/23/2024, R1 did not sign out of the log before leaving the facility and was not seen on the surveillance camera. LIC/ADM stated R1 was displaying wandering behavior during the first couple of days of admission. R1 would leave the facility building and walk towards the main gate, however, staff is able to stop R1 prior to the incident from leaving because staff was always present by the front gate. ADM stated R1 can understand English and speak English. Continuation on LIC 9099-C, Page 2 of 3 On 4/9/2025, LPA Partoza, attempted to interview R1 by asking questions. R1 would respond with one word answers which are "yes" or "no" . R1 was not able to state his/her name, date of birth or today's date but will communicate with ADM and facility staff. Based on review of R1’s Physician’s Report dated 7/25/2024, R1 is able to leave facility unassisted but does not specify if R1 is confused/disoriented or has wandering behavior. Based on review of R1’s Appraisal/Needs and Services Plan 9/25/2024, states R1 is monolingual and does not speak English. Based on review of Visitor Sign In/Sign Out log, R1 did not sign out the day of 10/23/2024. Based on information provided by R1’s conservators (CO), the incident on 10/23/2024 was the first time out in the community and R1 was unfamiliar with the area and is very confused. CO stated R1 has been in a locked facility for 5 years (3/30/2019-10/2/2024) R1 was admitted to the facility on 10/3/2024. Based on interviews and observation/inspection of the facility, the preponderance of evidence has been met therefore the above allegations is found to be SUBSTANTIATED. Deficiencies were cited from California Code of Regulations, Title 22 on 1/8/2025 visit, see LIC 9099-D. However the case does not meet the criteria of absence of supervision, there for no civil penalty is warranted. The Plan of Correction (POC) have been submitted to Community Care Licensing (CCL). An exit interview was conducted with LIC/ADMs Virgil Valin and Amor Valin and a copy of the report was provided. Page 3 of 3 End of Reportthe state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Simi Rai and Marcela Yanez conducted an unannounced case management visit to conclude the investigation initiated on 10/24/2024. LPAs met Licensee/Administrator Amor Valin and Administrator Virgil Valin and stated the purpose of today’s visit. On 10/24/2024, the Department conducted a case management visit to follow up on an incident report received on 10/23/2024 regarding resident (R1) left the facility without staff knowledge and was reported missing by facility staff. On 10/24/2024, 3 staff were interviewed. 3 Out of 3 staff stated on 10/23/2024 during lunch time, approximately noon, they observed R1 present in the facility. Staff S2 stated during snack time which was at approximately 3:00pm, staff observed R1 was not present at the facility. Staff waited for R1 to return to the facility until dinner time at approximately 5pm and realized resident was not back at the facility. The facility staff searched around 3-mile radius but were not able to locate R1. R1 was reported to local law enforcement as missing person. 3 Out of 3 staff stated R1 had wandering behaviors and staff ensured R1 did not leave the facility and did not leave R1 alone. Staff stated they were not able to communicate and assess the R1’s needs because R1 did not speak English and they did not speak R1’s language. During today’s visit, LPAs interviewed ADM and LIC. R1 returned back to the facility on 10/24/2024 at 7pm. ADM stated all residents are supervised at the facility for the first month following their admission to the facility. ADM stated the day of 10/23/2024, R1 did not sign out of the log before leaving the facility. LIC stated R1 was displaying wandering behavior during the first couple of days of admission where R1 would leave the facility building and walk towards the gate located at the front of the facility. ADM stated R1 can understand English and speak English. Continuation on LIC 9099-C, Page 1 of 2. Page 2 of 2. During today's visit, LPAs interviewed R1. LPAs asked R1 questions and R1 would respond with one word answers such as "Yes" and "No". R1 was not able to answer basic questions as R1's name, date of birth or today's date. R1 is able to understand nonverbal cues such as pointing to the door when asked to close the door or pointing to the head when asked if R1's head hurts. Based on review of Incident Report 10/23/2024, Administrator stated the residents who leave the facility would return for dinner. Based on review of R1’s Physician’s Report dated 7/25/2024, R1 is able to leave facility unassisted but does not specify if R1 is confused/disoriented or has wandering behavior. Based on review of R1’s Appraisal/Needs and Services Plan 9/25/2024, R1 is monolingual and does not speak English. Based on review Visitor Sign In/Sign Out log, R1 did not sign out the day of 10/23/2024. Based on information provided by R1’s conservators (CO), the incident on 10/23/2024 was the first time out in the community and R1 was unfamiliar with the area and is very confused. CO stated R1 has been in a locked facility from 3/30/2019-10/2/2024 and R1 was admitted to the facility on 10/3/2024. Based on interviews and observation/inspection of the facility, the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 9099-D. A civil penalty is being assessed for the amount of $500 for the absence of supervision at the facility. Please see LIC421IM. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Licensee/Administrator Amor Valin and Administrator Virgil Valin and a copy of the report was provided. Appeal Rights was provided.the state’s words, verbatim · CDSS document, Jan 8, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1562.6(a) · Plan of correction due date: Jan 9, 2025

1562.6(a)The administrator of an adult residential care facility that provides services for residents who have mental illness shall ensure that a written intake assessment is prepared by a licensed mental health professional prior to acceptance of the client... This requirement is not met as evidenced by: Based on record review of R1, R1 has a mental illness, and a written intake assessment was not prepared by a licensed mental health professional prior to acceptance of the client which poses/posed an immediate Health, Safety, orthe state’s words, verbatim · CDSS document, Jan 8, 2025

Plan of correction: Licensee/Administrator stated to submit a written plan of action understanding regulation and will esnure residents have a written intake assessment prior to admission to the facility by POC due date. Licensee/Administrator agreed and understood. (con't) Personal Rights risk to persons in care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.2(a)(4) · Plan of correction due date: Jan 9, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(4) To care, supervision, and services that meet their individual needs ... by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on interviews conducted, resident R1 left the facility without the knowledge of the staff on 10/23/2024, staff did not provide R1 with care, supervision, and communication to meet his/her needs which poses/posed an immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 8, 2025

Plan of correction: Licensee/Administrator stated to submit a written plan of action understanding regulation and will train staff on providing care and supervision by POC due date. Licensee/Administrator agreed and understood.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Jan 9, 2025

87468.1 Personal Rights: (a)(2) Each resident shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interview and record review, on 10/23/2024 resident R1 left the facility without signing out on the logbook and staff were unaware of R1 leaving the facility for approximately 3 hours which poses/posed an immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 8, 2025

Plan of correction: Licensee/Administrator stated to submit a written plan of action understanding regulation and will train staff on providing care and supervision by POC due date. Licensee/Administrator agreed and understood.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Maria (Mita)Partoza, conducted an unannounced case management inspection for the incident report that was received by the Department on 10/23/2024 regarding a resident who eloped and was reported missing. LPA was met by Lourdes Basconcillo who stated she's the lead staff/house manager (LS/HM) for the facility. The licensee/administrator Virgil Valin and Amor Valin was not present and stated that they were flying out to attend a seminar. At 10:40 a.m. LPA toured the facility with LS/HM inside and outside and observed that walkways and pathways on the side and the front area are free from obstruction. LPA interviewed 3 staff (S1, S2, S3). 3 out of 3 staff stated that resident (R1) was very quiet and does not talk and likes to sit at the courtyard with other residents. R1 has a roommate (R2) who speaks the same language as R1. R2 stated that R1 does not say much and is quiet. 3 Out of 3 staff stated R1 was last seen by them in the morning and at lunch time. S2 stated he/she did not notice R1 during snack time at 3:00 p.m. LPA requested documents from LS/HM. Due to insufficient information this case management will remain open until further investigation. No deficiencies were cited during today's visit. An exit interview was conducted with Lead Staff/House Manager Lourdes Basconcillo. A copy of the report was provided. end of reportthe state’s words, verbatim · CDSS document, Oct 24, 2024

Type of visit: Required - 1 Year

On 8/15/2024, at 8:45 a.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced Required - 1 Year visit and met with Lourdes Bansoncillo lead staff (LS) for the facility. LS called the administrator Amor and Valin Virgil. ADMs stated that they out of town due to family emergency and have authorized LS to sign for the report. The facility services adults 60 years and over capacity of 24 of which 20 may be non-ambulatory. The facility has a current census of 17 residents who are ambulatory. At 9:00 a.m. LPA reviewed facility record, 5 of 17 resident record including their Centrally Stored Medication and Destruction record, 4 of 4 facility staff record and found all records to be complete and updated. The fire and earthquake drill are up to date. At 10:45 a.m. LPA toured the facility inside and outside, including 2 kitchen and 1 common dining area. The facility has four buildings #32, #34, #36 & #38. LPA observed no sharps, knives or toxic under the sinks, shelves and cabinets. LPA observed building maintenance is ongoing. LPA observed resident of which 5 of 17 are in their bedroom resting, 2 of 17 are in the common living room, 4 of 17 are watching TV at the covered porch 1 of 17 seated at the gazebo, and 2 of 17 by the courtyard seated and resting. LPA observed food supplies are stored in as separate area/building and shed. LPA observed 2 days of perishable and 7 days of non-perishable food, to LPA observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. See 809-C for more information. Page 1 of 2 LPA observe 7 fire extinguishers with service tags dated on 8/8/2023. LPA observed smoked, and carbon monoxide detectors that are functioning properly when tested. LPA observed resident bedrooms and observed each room to have functioning lights, drawers and smoke detectors. LPA observed the drawers to be free of sharps or unsecured medications and each bed to have sheets, blankets, and bed covers. LPA observed that all residents bedrooms have sufficient storage space for personal belongings and are kept sanitary and organized. LPA observed walkways and hallways to be free from obstructions, the courtyard is free from debris and kept maintained. The common living area was kept organized and sanitary. LPA observed four resident bathrooms and observed each bathroom to have functioning lights and showers with grab bars. The bathroom water temperatures measured from 97.7 degree F to 105 degree F. LPA observed that bathroom at building #38 located on the hallway has standing water in the shower area and along the toilet seat. Building #32 does not have any resident. LPA observed the shower curtain lining of the bathroom at bldg #32 is frayed/ripped at the bottom and stained with soap & water residue and observed that the sink has a counter marble block back splash that peeled off from the wall (photos were taken). LPA discussed with lead staff and administrator via a telephone call regarding housekeeping such as but not limited to changing shower liners, and ensuring bathrooms have no standing water and water temperature measures at 105 degree F to 120 degree F. LPA gave technical advisory. LPA requested a copy of the following: LIC 500, LIC 308, Liability Insurance, Administrator Certificate and resident roster. No deficiency was issued during today's visit based on California Code of Regulation and a copy of the report was provided. An exit interview was conducted with lead staff Lourdes Basconcillo. page 2 of 2 end of reportthe state’s words, verbatim · CDSS document, Aug 15, 2024