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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006579
Report Date: 06/27/2024
Date Signed: 06/27/2024 03:41:10 PM

Document Has Been Signed on 06/27/2024 03:41 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ALTER MENTAL HEALTH, LLCFACILITY NUMBER:
306006579
ADMINISTRATOR/
DIRECTOR:
NEKOU,NILOUFARFACILITY TYPE:
772
ADDRESS:33861 GRANADA DRIVETELEPHONE:
(949) 538-7457
CITY:DANA POINTSTATE: CAZIP CODE:
92629
CAPACITY: 6CENSUS: 0DATE:
06/27/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Whitney BussTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Whitney Buss, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Social Rehabilitation Facility. Application was submitted to Community Care Licensing on 05/16/2024. This is a change of location with persons in care.
During the inspection, LPA and AP observed the following: Structure: facility is a 4-bedroom, 4-bathroom, 2-story house with a detached garage that is being used for storage and activities. Facility telephone number is (949) 317-3577. 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. Staff Bedrooms: there are no staff bedrooms. Bathrooms: were clean, faucets and toilets were operational. Water temperature: tested at 106 degrees F in all 3 client bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed 7 days nonperishable food supply and AP stated they will obtain 2 days’ perishable food supply prior to admitting their first client. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the storage closet. Toxins: observed locked in the cleaning closet. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Client & Staff Files: LPA reviewed client and staff file storage area. Fire clearance was approved by Orange County Fire Authority on 05/30/2024. Backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and sufficient seating for clients. Component III was completed with AP during today’s inspection. LPA reviewed relocation plan with AP. AP stated that the clients will be relocated the same day as their belongings, medications, and food once the relocation has been approved. Staff will provide care and supervision during the entire moving process. Facility is currently operating under the liability insurance of current facility ALTER MENTAL HEALTH (306006083). AP will switch liability insurance to new facility once the application is approved. During the inspection, LPA 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: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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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