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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603003
Report Date: 06/21/2024
Date Signed: 06/21/2024 02:28:45 PM


Document Has Been Signed on 06/21/2024 02:28 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:ALTA LOMA GARDENS RESIDENTIAL CARE #2FACILITY NUMBER:
198603003
ADMINISTRATOR:STARK PLEITEZ, ANA MFACILITY TYPE:
740
ADDRESS:1667 WOODBEND DRTELEPHONE:
(818) 922-5427
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:6CENSUS: 6DATE:
06/21/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:56 PM
MET WITH:Direct Support Staff (DSP) Alvin John EspinoTIME COMPLETED:
02:30 PM
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LPA Ramirez was greeted by Direct Support Staff (DSP) Alvin John Espino and explained the purpose of the visit. LPA Ramirez returned to the facility to clear deficiency issued on 6/04/2024 during annual inspection. LPA Ramirez observed R3 resident file, and emails from Admin Cert Unit indicating Administrator Ana M Barrera Pleitez (6035281740) certificate is pending verification. Administrator Pleitez will forward certificate to LPA once it is issued. No further action is required. Deficiency has been cleared.

Exit interview was conducted. A copy of this report, and Letter of Deficiencies Cleared, was provided.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly RamirezTELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2024
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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