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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006576
Report Date: 01/09/2025
Date Signed: 01/09/2025 09:30:06 AM

Document Has Been Signed on 01/09/2025 09:30 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:HOME WITH ALOHAFACILITY NUMBER:
306006576
ADMINISTRATOR/
DIRECTOR:		IGARTA, ALICIAFACILITY TYPE:
735
ADDRESS:711 BUENA VISTA AVETELEPHONE:
(562) 458-0629
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 4CENSUS: 0DATE:
01/09/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:38 AM
MET WITH:Alicia IgartaTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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Licensing Program Analysts (LPAs) Sean Haddad, Hanna Gough, and Nancy Guillen conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPAs met with Applicant (AP) Alicia Igarta, discussed the purpose of the inspection, and toured the facility. Facility is to operate an Adult Residential Facility. Application was submitted to Community Care Licensing on April 22, 2024. This is an initial application with no clients in care.

During the inspection, LPAs and AP observed the following: Structure: this is a one-story home. Facility is a 4-bedroom, 2-bathroom, one-story home with an attached garage that will be used for storage. There is a shaded outdoor area with furnishings for client use. LPAs observed a low-lying fence in the backyard; licensee stated they will install a full fence before accepting their first client. Facility telephone number is (562) 324-0293. Client Bedrooms: the 4 client bedrooms are spacious and will easily accommodate the clients’ furnishings. Lamps, chairs, linens, and storage for each client bedroom inspected. Bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 110.3 F degrees in the common client bathroom and 108.3 in the private bathroom. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed in the hallway. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPAs observed the seven-day non-perishable supply. Licensee stated they will obtain a two-day perishable supply of food prior to obtaining new clients. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested.

Continued on LIC 809-C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HOME WITH ALOHA
FACILITY NUMBER: 306006576
VISIT DATE: 01/09/2025
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Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in a lock box in a kitchen drawer. Toxins: will be locked in the garage. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Client & Staff Files: this is an initial inspection. LPAs observed storage area for client and staff files. Fire clearance was approved by LA County Fire Authority on July 23, 2024. Backyard exit gate is operational and unlocked. Back yard has shaded area for outdoor activities and sufficient seating for clients. Component III was completed with AP during today’s inspection.

During the inspection, LPAs explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. An exit interview was conducted and a copy of this report was discussed with and provided to AP.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC809 (FAS) - (06/04)
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