335530040-1-30-2023-56-AS-ACON-CNKSR9-20230130130558

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 335530040
Report Date: 01/30/2023
Date Signed: 01/30/2023 01:06:15 PM

Document Has Been Signed on 01/30/2023 01:06 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	CASA ALMAR		FACILITY NUMBER:	335530040
ADMINISTRATOR:	ALCOCER, PETER		FACILITY TYPE:	735
ADDRESS:	5251 ALMAR STREET		TELEPHONE:	(714) 448-0533
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92505
CAPACITY: 4		CENSUS: 3	DATE:	01/30/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Blanca Cortez, Former Administrator		TIME COMPLETED:	01:05 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, Amber Coleman arrived at the Casa Alamar facility to conduct a Pre-Licensing Visit for the purposes of Change of Ownership. LPA met with new Administrator Peter Alocar (Administrator Peter) upon entry to facility. LPA was then greeted and granted entry by former Administrator Blanca Cortez (Administrator Blanca). LPA made introductions and stated the purpose of the visit. LPA signed in and was provided a space to work, then completed a walk through of the facility premises. Blanca reported that there are currently 3 residents in care, who are all at their prospective day programs. Application for change of ownership for an Adult Residential Facility is dated 9/29/2022, for a capacity of 4 ambulatory residents. Last Fire Clearance granted on 9/1/2022. Structure: Facility was a one-story house with four (3) resident bedrooms, one (1) staff bedroom, one (1) resident bathroom and one (1) staff bathroom, living room, den, dining area and kitchen. There was an attached two (2) car garage. Facility Sketch on file shows Bedroom #4 as a client room. During the walk through, Administrator Blanca explained that Bedroom #4 has been converted to a staff room. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control the entire house. Temperature noted at 78 degrees during walk through. Bedrooms: Each resident bedrooms accommodate each ambulatory resident. LPA Brown observed each of resident bedrooms were adequately furnished with bed, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Bathrooms: Three residents share one bathroom. Bathroom found equipped with operable toilet, 2 sinks, shower and adequate paper and hand soap. Extra hygiene materials located underneath each sink. At 10:40am LPA tested the water temperature in the resident bathroom. LPA verified water temperature was measured at 108 degrees Fahrenheit.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CASA ALMAR	FACILITY NUMBER: 335530040
	VISIT DATE: 01/30/2023

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

Kitchen/Laundry:
An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were observed to be secured in drawer. There was adequate room for food storage. LPA Brown observed the stove to be operational. Refrigerator/freezer were in working condition. There is sufficient storage for perishable food. There was adequate seating for meals for all residents. Laundry room with washer and dryer was adjacent to the hallway. Laundry detergents and cleaning supplies were observed in the garage, garage door is locked away from residents.

Living/Family room:
There was a living/family room with adequate seating for all residents and a working TV.

Linens and Hygiene Supplies:
An adequate supply of linens was stored in a cabinet in the main hallway of the residence.

Yards/Outside:
Sufficient patio furniture for outdoor seating observed. Both walkways free of obstruction. LPA observed an in ground pool in the backyard. Pool was secure with gate and made inaccessible to residents in care.

Emergency Phone Numbers, and Exit Plan:
Facility sketch were observed posted in the hallway leading to the residents bedrooms. There were Ombudsman poster, and Emergency Disaster Plan posted. However, no Let-Us-No poster was observed. Additionally, LPA observed several signs for infection control posted throughout facility.

General items:
LPA located (1) fire extinguisher posted on Kitchen wall. Found to be fully charged. Last inspected 1/1/23.
LPA located and 5 fire alarms, all in working order. 1 carbon monoxide alarm tested and found operational.
Resident and staff records were stored in a locked cabinet in the kitchen. Medications are kept in a secure hallway closet along with the first aide kit and emergency lighting. LPA observed a facility phone and was operational as evidenced by LPA. Facility phone number is 951-343-7242.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CASA ALMAR	FACILITY NUMBER: 335530040
	VISIT DATE: 01/30/2023

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

***CONTINUED FROM LIC 809***
There is enough Emergency water supply observed and the required 72-hour emergency food supply was discernible from the regular food supply. Supplies are kept secure in the garage attached to the kitchen. LPA also observed an additional refrigerator for extra food and staff use. Component III was completed on this day as well.

Additionally, LPA observed facility to have required single entry point for COVID-19 screening, upon entering facility. LPA Brown observed required COVID signs throughout the facility and Sign-in Sheet with Covid-19 Symptom Questionnaire Log.

LPA advised New Administrator Peter Alocar to submit an updated facility sketch. As well as get staff members associated to the facility. LPA and New Administrator coordinated a time and date to get tasks completed within 2 weeks.

A follow up Pre-Licensing Visit along with LIC809 will be generated upon resolution of set tasks.

An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator/Applicant Peter Alocar.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3