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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006520
Report Date: 07/08/2024
Date Signed: 07/08/2024 12:45:27 PM

Document Has Been Signed on 07/08/2024 12:45 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:ALTER BEHAVIORAL HEALTH - CAPISTRANO BEACH, LLCFACILITY NUMBER:
306006520
ADMINISTRATOR/
DIRECTOR:		LEMME, WILLIAMFACILITY TYPE:
772
ADDRESS:33452 VIA DE AGUATELEPHONE:
(949) 538-7457
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 6CENSUS: 0DATE:
07/08/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:14 AM
MET WITH:Whitney BussTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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) Joseph Alejandre conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with the compliance manager Whitney Buss and toured the facility.

An initial application to operate a Social Rehabilitation Facility (SRF) was submitted to CCL on January 02, 2024. The facility is to have a capacity of 6 Ambulatory clients. Facility phone number 949-402-5539. LPA observed the following.

Structure:
The facility is a two story house with an attached 3 car garage with 4 bedrooms (1 is used as a staff office), 3 bathrooms, dining room, a kitchen, living room and family room.

Air/Heating:
Central air/heating system installed with a central panel to control entire house. The air conditioning was operating during the visit.

Client Bedrooms:
There are 3 client Bedrooms and each bedroom can be shared. The bedrooms are spacious and will easily accommodate the clients' belongings. All client rooms had the required furnishings and linens.

Medications, First-Aid Kit & Book:
There is a first aid kit on each floor. Both first aid kits had all required elements. Medications will be stored in a locked cabinet in the staff office.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: ALTER BEHAVIORAL HEALTH - CAPISTRANO BEACH, LLC
FACILITY NUMBER: 306006520
VISIT DATE: 07/08/2024
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
26
27
28
29
30
31
32
Bathrooms:
All three bathrooms are clean and operational. Hot water measured from 113.0 degrees Fahrenheit to 115.1 degrees Fahrenheit in all 3 bathrooms.

Linens & Hygiene Supplies:
Adequate supply of linen stored in hall closet. Extra hygiene supplies are stored in the garage.

Emergency Phone Numbers, Exit Plan & Menu:
Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food served for one week.

Food Service:
There are no clients in the facility. There is an emergency supply of food and water stored in the garage. No other food is at the facility.

Smoke Detectors/Carbon Monoxide Detectors:
Smoke detectors/carbon monoxide detectors tested operational. The fire extinguishers in the kitchen and at the top of the stairs are fully charged.

Appliances:
There is a 6 burner gas stove top, 2 wall mounted ovens, microwave oven and refrigerator and a dishwasher in the kitchen. The washer and dryer are in first floor laundry room. All appliances are clean and operational.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: ALTER BEHAVIORAL HEALTH - CAPISTRANO BEACH, LLC
FACILITY NUMBER: 306006520
VISIT DATE: 07/08/2024
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
26
27
28
29
30
31
32
Client & Staff Files:
The Client and Staff Records will be kept locked in the office

Reading Material, Games, Equipment & Materials:
Board games and puzzles are stored in the living room. There is a large screen TV mounted in the living room.

Fire clearance:
Fire Clearance approved by Orange County Fire Authority Inspector Andrew Miller on March 7, 2024.

Component III:
Component three was waived because the Licensee owns and operates other licensed facilities.

Facility is ready to be licensed. LPA will submit notification to CAB (Central Applications Bureau) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento.

Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3