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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002989
Report Date: 06/20/2024
Date Signed: 06/20/2024 09:35:12 AM


Document Has Been Signed on 06/20/2024 09:35 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ALPINE BOARD AND CAREFACILITY NUMBER:
345002989
ADMINISTRATOR:NOVELL, ALEXFACILITY TYPE:
740
ADDRESS:6725 LINCOLN OAKS DRIVETELEPHONE:
(650) 771-4466
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 3DATE:
06/20/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Alex Novell and China Washington, AdministratorsTIME COMPLETED:
08:30 AM
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An informal conference was conducted at 7:30am on June 20, 2024, with Sacramento North Regional Office via Microsoft Teams. The purpose of this informal conference meeting is to address citations issued during inspection conducted on 5/20/2024. The Administrators were told that this Informal conference is a part of the Administrative Action process and that further noncompliance may result in an elevation to a formal noncompliance conference, which could lead to a referral to the Department's legal division for possible revocation of license.

The following Licensing staff were present:
Licensing Program Analyst (LPA) Michael Hood and Licensing Program Manager (LPM) Anthony Perez

The following facility representatives were present:
Administrators Alex Novell and China Washington

The following topics were covered during today's meeting:
· An overview regarding 3 Type A citations, 2 substantiated complaint allegations, and 1 civil penalty
· Care and supervision, including on-call night supervision during NOC shift and Administrator presence at the facility.

Administrators are working on pending corrections that will be completed and submitted to LPA by 6/27/2024. Facility was notified that the Department may increase monitoring at the facility. Technical support was offered to facility representatives during meeting.

An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy must be signed and returned to the Department.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024
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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