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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002440
Report Date: 03/06/2025
Date Signed: 03/06/2025 12:08:25 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/06/2025 12:08 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/
DIRECTOR:		MALACA, ROCHELFACILITY TYPE:
740
ADDRESS:24606 SATURNATELEPHONE:
(949) 533-5938
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 0DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:49 AM
MET WITH:Khadija Baha- AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of conducting the required annual inspection visit. LPA rang the bell with no response. Facility appeared vacant through the front window. LPA spoke to Administrator (Admin) Kimberly Arnett by telephone at 10:50am who confirmed that this licensed location is not operational at this time and has been acquired by the previous licensee. The team from the new ownershi including Administrator Kimberly arrived on premise to grant facility access. LPA conducted the walk through and confirmed by a tour of the physical plant to not be under operation.

Administrator Khadija Baha arrived approximately 11:55am and confirmed that the facility has been closed approximately 2023 or 2024. Admin will verify the date of closure and will provide the copy of the written closure request submitted to the Department to LPA. On today's date, Administrator Khadija Baha surrendered the original license and was informed of the current balance due.

The Department will now proceed with the closure.

An exit interview was conducted with Administrator Khadija Baha, and a copy of this report was provided at the end of the visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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