<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001396
Report Date: 03/15/2024
Date Signed: 03/15/2024 10:49:29 AM

Document Has Been Signed on 03/15/2024 10:49 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ALEXA'S HOMEFACILITY NUMBER:
306001396
ADMINISTRATOR:PATRICIA FESTINFACILITY TYPE:
735
ADDRESS:3117 W. CUBBONTELEPHONE:
(657) 245-3165
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY: 6CENSUS: 3DATE:
03/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:Patricia Festin-AdministratorTIME COMPLETED:
11:04 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver an amended report and conduct a case management visit in conjunction with complaint visit 22-AS-20231211135300. LPA was greeted and granted entry into the facility and met with Administrator (AD) Patricia Festin. LPA explained the reason for the visit.

During the investigation LPA reviewed documents including the Record of Client’s Safeguarded Cash Resources dated 09/30/23-12/26/23 for Client 3 (C3). Per records reviewed for C3 the Personal & Incidental (P&I) Funds ledger dated 12/20/23 the total balance was $2,368.63; however, the total cash on hand accounted for was $2,661.41. Therefore, the P&I ledger is inaccurate.

Based on today's visit, a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with Wellness Coordinator (WC) and a copy was provided as well as Appeal Rights.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
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
Document Has Been Signed on 03/15/2024 10:49 AM - It Cannot Be Edited


Created By: Alvaro Ramirez Jr. On 03/15/2024 at 10:30 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ALEXA'S HOME
FACILITY NUMBER: 306001396

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2024
Section Cited
CCR
80026(h)

1
2
3
4
5
6
7
Safeguards for Cash Resources, Personal Property, and Valuables of Residents (h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care. This requirement is not met as evidence by:
1
2
3
4
5
6
7
Licensee/Administrator agrees to read regulation and sign a statement of understanding and forward proof to LPA by POC due date.
8
9
10
11
12
13
14
During the intial visit on 12/20/23 the P&I ledger for C3 and the cash on hand did not matched.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2