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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609804
Report Date: 06/16/2022
Date Signed: 06/16/2022 03:43:46 PM

Document Has Been Signed on 06/16/2022 03:43 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:
06/16/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Moses WakabiTIME COMPLETED:
03:50 PM
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At 2:10 p.m. on 06/16/2022 Licensing Program Analyst (LPA) Nicholas Reed conducted an announced case management visit. LPA met with Administrator and BCBA and disclosed the reason for the visit.

Licensee submitted an incident report on 06/09/2022 regarding Resident #1 (R1) who AWOLed from the facility and was found by police in Pacoima. R1 also AWOLed on 01/28/2022.

At 2:15 p.m. LPA interviewed BCBA. At 2:25 p.m LPA interviewed R1. At 2:40 p.m. LPA interviewed the administrator

At 3:00 p.m. LPA, Administrator, and BCBA reviewed R1’s Individual Service Plan and Quarterly Report. LPA also reviewed the facility’s plan of operation.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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