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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880883
Report Date: 06/12/2024
Date Signed: 06/12/2024 09:52:06 AM

Document Has Been Signed on 06/12/2024 09:52 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ALPHA CHRISTIAN HOMES AT EDEN WAY INCFACILITY NUMBER:
331880883
ADMINISTRATOR/
DIRECTOR:		MELVIN DAILOFACILITY TYPE:
735
ADDRESS:1082 EDEN VALLEY WAYTELEPHONE:
(562) 569-8115
CITY:SAN JACINTOSTATE: CAZIP CODE:
92582
CAPACITY: 4CENSUS: 4DATE:
06/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Administrator, Melvin DailoTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On 6/12/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to conduct an annual required inspection. LPA was greeted and granted entry by Caregiver, Anthony Tubig who was informed of the purpose of the visit. Administrator, Melvin Dailo arrived during the visit. The facility has a fire clearance for four (4) ambulatory clients and serves adults ages 18 through 59.

During the visit, there was one (1) client and two (2) staff present and LPA was informed three (3) clients were at day program. LPA toured the facility with Caregiver Tubig. During the tour, LPA observed the facility is made up of a one (1) story home with four (4) client bedrooms and two (2) bathrooms along with a kitchen, dining room, living room and attached garage. LPA did not observe any bodies of water on the premises. Indoor and outdoor passageways are free of obstruction. LPA observed charged fire extinguishers mounted throughout the facility. Caregiver, Ariel Servano tested one (1) of the smoke alarm/carbon monoxide detectors and LPA observed it to be operational. Disinfectants and cleaning solutions are secured in a locked hallway closet. Client bedrooms were each furnished with a bed, chair and night stand. Bathrooms have a working toilet, wash basin and non-skid mats in the shower. LPA toured the kitchen and observed the facility had a 2-day supply of perishable foods and 7-day of non-perishable food items. Food is stored in a safe and healthful manner. Medications were secured in a hallway closet. LPA reviewed the physical medications for two (2) clients as well as their Medication Administration Record and did not discover any discrepancies. LPA also reviewed random client and staff files. Client files reviewed had updated Individual Program Plans and signed admission agreements. Staff present have a criminal record clearance, are associated with the facility, and have a valid first aid/CPR and CPI nonviolent crisis intervention certification. The facility offers several outdoor shaded seating areas for the clients along with activities and outings.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Administrator Dailo.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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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