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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603681
Report Date: 02/29/2024
Date Signed: 02/29/2024 11:27:13 AM

Document Has Been Signed on 02/29/2024 11:27 AM - 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:ALEXANDER'S HOUSE INCORPORATEDFACILITY NUMBER:
198603681
ADMINISTRATOR:DROUGHN, LAWRENCEFACILITY TYPE:
735
ADDRESS:1791 NAVARRO AVETELEPHONE:
(626) 298-6605
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY: 5CENSUS: 5DATE:
02/29/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Queen Kelli - Droughn - AdministratorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Tena Herrera conducted an announced pre-licensed visit and met with Administrator Queen Kelli Droughn and Licensee Lawrence Droughn for the purpose of conducting a Pre-Licensing Inspection / Component III visit. This Pre-Licensing Inspection is due to a change of ownership.

The facility has an approved fire clearance to be licensed to serve five (5) ambulatory clients. The facility is a single-story home located in a residential area in Pasadena, Ca. A tour of the facility includes: living room, dining room, kitchen, 3 bedrooms, 1 bathrooms, detached garage, front yard and back yard.

The physical plant was toured inside and out alongside Queen and Lawrence Droughn.


The following was observed/inspected:

· There is a locked storage area that is centrally located for medication.

· Cleaning supplies are kept separate from food and located in a locked cabinet.

· Facility walls, ceilings, floors, window screens and areas around the facility are clean and in good repair.

· Fire extinguishers and smoke detectors operate properly.

· Doors and passageways are free of obstruction.

· There are no pools/bodies of water at the facility.

· Facility does not have firearms on premises.

(Continued on 809-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ALEXANDER'S HOUSE INCORPORATED
FACILITY NUMBER: 198603681
VISIT DATE: 02/29/2024
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· There is an emergency exiting plan with emergency phone numbers posted.

· Facility has a current disaster and mass casualty plan maintained at the facility.

· There is a plan for employee accommodations and staffing arrangements.

· Operating telephone is on the premises and will be available to clients.

· Client Records were observed and have all the appropriate documents/records in their file.

· First-aid supplies are maintained and readily available.

· Refrigerator and freezer were observed and are maintained at the correct temperatures.

· Food storage and preparation are clean and appropriate for food preparation.

· Hot water temperature was tested and is within the required range of 105-120 degrees F.

· Facility van has valid insurance and registration.

Component III was completed during todays visit and reviewed by Queen and Lawrence Droughn.

An exit interview was conducted, and a copy of this report has been furnished to Administrator Queen Kelli Droughn. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC809 (FAS) - (06/04)
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