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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002440
Report Date: 08/23/2023
Date Signed: 08/23/2023 01:43:19 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/12/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230712110106
FACILITY NAME:ALPINE BFACILITY NUMBER:
306002440
ADMINISTRATOR:BAHA, KHADIJA (HEIDI)FACILITY TYPE:
740
ADDRESS:24606 SATURNATELEPHONE:
(949) 380-3010
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 0DATE:
08/23/2023
UNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Rochele Malaca, Administrator (via phone)
Kim Walters
Michelle Nesbitt		TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility staff is not following proper facility closure procedures
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the allegations listed above. LPA was greeted and granted entry by maintenance staff after explaining the purpose of the visit. Facility staff arrived later to assist with the visit. LPA listed the allegations investigated.

An initial complaint investigation visit took place on July 17, 2023. At the time, one resident remained within the facility as the sale of both the business and the property was scheduled to be final on July 21, 2023. LPA conducted an interview with one staff member present as well as facility administrator Khadija "Heidi" Baha and reviewed records for resident R1. A follow-up visit was held on August 1, 2023. Interviews were conducted with facility administrator Rochel Malaca and Kim Walters. Records for four residents who moved out of the facility in June 2023 were requested and provided.

CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/12/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230712110106

FACILITY NAME:ALPINE BFACILITY NUMBER:
306002440
ADMINISTRATOR:BAHA, KHADIJA (HEIDI)FACILITY TYPE:
740
ADDRESS:24606 SATURNATELEPHONE:
(949) 380-3010
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 0DATE:
08/23/2023
UNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Rochele Malaca, Administrator
Kim Walters
Michelle Nesbitt		TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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2
3
4
5
6
7
8
9
Residents were illegally evicted
INVESTIGATION FINDINGS:
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13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the allegations listed above. LPA was greeted and granted entry by maintenance staff after explaining the purpose of the visit. Facility staff arrived later to assist with the visit. LPA listed the allegations investigated.

An initial complaint investigation visit took place on July 17, 2023. At the time, one resident remained within the facility as the sale of both the business and the property was scheduled to be final on July 21, 2023. LPA conducted an interview with one staff member present as well as facility administrator Khadija "Heidi" Baha and reviewed records for resident R1. A follow-up visit was held on August 1, 2023. Interviews were conducted with facility administrator Rochel Malaca and Kim Walters. Records for four residents who moved out of the facility in June 2023 were requested and provided.

CONTINUED ON FORM LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20230712110106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ALPINE B
FACILITY NUMBER: 306002440
VISIT DATE: 08/23/2023
NARRATIVE
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CONTINUED FROM FORM LIC9099
The facility's physical plant was toured during both inspection visits. Additional witness interviews with responsible parties of all former residents were also conducted.

Regarding the allegation that Residents were illegally evicted, the following has been concluded: Residents and their responsible parties were notified ahead of the intended change of ownership that the licensee had plans to sell both the business and the property. Prior to the closure of the sale, they were additionally informed of the identity of the prospective new owner. During the week of June 25, 2023, responsible parties were notified by the prospective owner that they recommended to relocate their relatives, with a variety of motives being provided at the time. Adequate 30-day notice was not documented to have been provided, however the four responsible parties who agreed to relocate at that time confirmed that they had the awareness of their ability to decline the move and/or the facilities offered and that the move had been voluntarily agreed to on their end. Another responsible party declined to authorize the move at the time and was served a 60-day notice on July 21, 2023 after the sale became final. The last resident moved out of the facility voluntarily on August 17, 2023.

As a result, the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened or is without a reasonable basis. The Department has investigated this complaint.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20230712110106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ALPINE B
FACILITY NUMBER: 306002440
VISIT DATE: 08/23/2023
NARRATIVE
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CONTINUED FROM FORM LIC9099
The facility's physical plant was toured during both inspection visits. Additional witness interviews with responsible parties of all former residents were also conducted.

Regarding the allegation that Facility staff is not following proper facility closure procedures the following has been concluded: Based on the investigation conducted, it was determined that licensee Khadija "Heidi" Baha notified all five residents and their responsible parties of her intent to sell the facility over 30 days prior to the finalization of the sale. It was however established that prospective administrators took action in relocating several of the residents on or around June 30, 2023 which was prior to their official designation in the capacity of facility administrators which was processed by the Department on July 21, 2023. As a result, they did not yet have the authority to carry out the policies of the licensee at the time that responsible parties were instructed to move out their relatives to other facilities operated by the prospective new owner.

As a result, the allegation is found to be Substantiated, meaning that the threshold of evidence standard has been met. A Type B citation is issued on the attached form LIC9099-D.

An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20230712110106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ALPINE B
FACILITY NUMBER: 306002440
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2023
Section Cited
CCR
87405(b)
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The California Code of Regulations Section 87405(b) states that: "The administrator of a facility (...) shall have the responsibility and authority to carry out the policies of the licensee". This requirement is not met as evidenced by:
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The facility was confirmed as closed and no longer having any residents in care by a case management visit conducted on this day by LPA and licensee. Facility will reopen under new licensure after the new application is processed and pre-licensing visit has been conducted.
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Based on interviews conducted, the administrator from the prospective facility owner took action to initiate the relocation of multiple residents prior to being designated as the administrator for the facility. This constitutes a potential risk to the health, safety and welfare of residents in care.
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As a result, the deficiency is cleared during the visit.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5