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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609804
Report Date: 05/18/2022
Date Signed: 05/18/2022 12:01:29 PM

Document Has Been Signed on 05/18/2022 12:01 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ALLIANCE ADULT RESIDENTIAL HOMES INCFACILITY NUMBER:
197609804
ADMINISTRATOR:WAKABI, MOSES DFACILITY TYPE:
735
ADDRESS:7821 HESPERIA AVENUETELEPHONE:
(747) 254-4154
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 4CENSUS: 4DATE:
05/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Moses WakabiTIME COMPLETED:
12:10 PM
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At 10:50 a.m. on 05/18/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

The facility was last visited on 01/18/2022 for a complaint visit. It is a single story building with 4 bedrooms, 2 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 4 ambulatory clients.

Entry: LPA observed a maintained front yard. A handwashing station with water and liquid soap is set up at the main entrance. Signs indicating the facility’s visitation policy are hung on the front door.

Screening: LPA was screened for infectious disease upon entry. The screening station contained a digital thermometer, visitor log surgical masks, hand sanitizer, and N95 respirators. LPA recorded name and contact tracing information in the visitor log. LPA advised Administrator to add columns for temperature, symptoms, and proof of vaccination in the visitor log.

Kitchen: LPA observed an adequate supply of perishable and non-perishable food in fridges and freezers. Stove burners were functional. All surfaces were sanitary. Sharp objects and cleaning solutions were locked below the sink. Medications were locked in a closet near the main entrance. At 11:05 a.m. LPA observed a fully charged fire extinguisher in the kitchen. A receipt from 08/26/2021 was taped on the fire extinguisher.

Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. At 11:10 a.m. LPA measured the room temperature to be 75.9 degrees. LPA observed postings in the dining room for the facility’s house rules, grievance procedures, Emergency Disaster Plan, facility sketch, personal rights, and COVID related signs.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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 2
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ALLIANCE ADULT RESIDENTIAL HOMES INC
FACILITY NUMBER: 197609804
VISIT DATE: 05/18/2022
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Bedrooms: The facility has 4 bedrooms. All bedrooms are private. All bedrooms contained a nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition.

Bathrooms: The facility has 2 bathrooms. All bathrooms contained liquid soap, paper towels, trash can with a lid, and a non-skid mat in the shower. At 11:11 a.m. LPA measured the water temperature in Bathroom #1 to be 119.5 degrees Fahrenheit.

Garage: Staff used a key to open the locked garage. LPA observed a washer and dryer in working condition. Detergent was locked in a cabinet near the appliances. Extra water, paper supplies, PPE, and additional refrigerators and freezers were also stored in the garage.

Safety: All emergency exit paths were free from obstructions. Exit gates were unlocked. At 11:19 a.m. LPA tested the dual-purpose smoke and carbon monoxide detector to be operational. LPA heard auditory alarm function for 3 out of 3 facility doors.

Outdoor areas: A covered patio area contained furniture in good repair. The rear black gate was locked with a deadbolt. The gate allowed access to the back alley. 2 bicycles and 1 scooter were located in the back yard.

During today's inspection, the facility is in compliance with Title 22 regulations.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
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