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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002440
Report Date: 03/18/2024
Date Signed: 03/18/2024 04:41:18 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/18/2024 04:41 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ALPINE BFACILITY NUMBER:
306002440
ADMINISTRATOR:MALACA, ROCHELFACILITY TYPE:
740
ADDRESS:24606 SATURNATELEPHONE:
(949) 533-5938
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 0DATE:
03/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Tammie Sampedro, Executive Administrator
Jozef Springer, Assistant Administrator		TIME COMPLETED:
04:50 PM
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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 conducting the required annual inspection visit. LPA rang the bell with no response and later called Executive Administrator Tammie Sampedro who confirmed that this licensed location was not operational at this time as it had initially been witnessed in a visit dated August 23, 2023.

Assistant Administrator Jozef Springer was dispatched to the location to greet and grant entry to LPA.

The location is confirmed by a tour of the physical plant to not be under operation at this time. Licensee is instructed to notify the Department before resuming operations.

No deficiencies are noted per Title 22 of the California Code of Regulations. 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: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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