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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880883
Report Date: 06/24/2026
Date Signed: 06/24/2026 03:05:50 PM

Document Has Been Signed on 06/24/2026 03:05 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, 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: 3DATE:
06/24/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:38 PM
MET WITH:LEAD CARE GIVER, DIVINA DELOSTRICOTIME VISIT/
INSPECTION COMPLETED:
03:18 PM
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On June 24, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Annual Inspection and met with Lead Staff, Divina Delostrico. The facility file review was conducted and additional records were requested and reviewed on site. This facility is licensed for four Adults and is currently operating a census of three Adults. For a 735 facility type.

LPA Mixson toured the facility along with Divina Delostrico and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways. Currently there are no bodies of water on the premises. This home is a single-story dwelling and is located at 1082 Eden Valley Way, San Jacinto, CA. 92582.

Facility phone number is (951) 350-0804 and it is operable. LPA observed the three residents’ bedrooms, and each was equipped with the required items as per Licensing and Title 22. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations. Bathrooms were clean and free of unpleasant odors at the time of this visit.

The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA observed the required signage and emergency phone numbers as required by regulations.

The cleaning supplies and sharp items were locked and inaccessible to the residents in care at the time of this visit. There was a designated storage space for staff and resident files and it was locked in the kitchen closet.

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Venus Mixson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ALPHA CHRISTIAN HOMES AT EDEN WAY INC
FACILITY NUMBER: 331880883
VISIT DATE: 06/24/2026
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LPA reviewed staff files and reviewed the staff schedule. Staff files reviewed have criminal clearance and updated training along with First Aid Certification, and current TB Test. Resident files reviewed possessed requested documentation and current weight records, along with current TB test.

The medications were locked and inaccessible to residents in care at the time of this visit. LPA observed a sufficient supply of medication for each resident. There were no documented errors on the medication administration records currently.

The facility is clean, furniture is in good condition, and home is free of unpleasant odors. Facility's cooling system and other appliances were operable currently at the time of this visit. LPA observed that there were night lights for safety throughout the facility.

Non-perishable and perishable food items were sufficient per regulations, and there are a variety of food types available for residents. The kitchen utensils and other dishes sufficient and stored properly. The sharp items were locked at the time of this visit.

LPA observed that there were adequate staff are present for the supervision of residents in care. Three staff total and engaging residents. Floor plans, telephone numbers and personal rights were found posted in the facility. Listed Administrator, Melvin Deilo, possesses a current administrator’s certificate with an expiration date of 11/04/2027, and it is posted in the facility.

LPA Mixson reviewed facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill was conducted on 05/31/2026 and conducted by Ariel Servano, Lead Staff.

LPA Mixson observed the hand washing stations in the facility restrooms, PPE equipment, and cleaning supplies. LPA reviewed the facility's infection control plan and found required infection control measures.



There were no observable deficiencies noted or cited per Title 22, Division 6 of the California Code of Regulations at the time of this annual inspection.

An exit interview was conducted where a copy of this report was discussed and given to Divina Delostrico,Lead Care Giver.
NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Venus Mixson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2026
LIC809 (FAS) - (06/04)
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