361881185-4-13-2023-56-AS-BALN-CQUST8-20230413140907

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 361881185
Report Date: 04/13/2023
Date Signed: 04/13/2023 02:09:19 PM

Document Has Been Signed on 04/13/2023 02:09 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
, CA 92507

FACILITY NAME:	ALBERTO CARE CENTER		FACILITY NUMBER:	361881185
ADMINISTRATOR:	LAYGO, ALLISON		FACILITY TYPE:	735
ADDRESS:	13542 LAKOTA ROAD		TELEPHONE:	(951) 347-0895
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92308
CAPACITY: 6		CENSUS: 0	DATE:	04/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Rufina Laygo-Staff		TIME COMPLETED:	02:15 PM

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Licensing Program Analysts (LPA's) Bernadette Allen and Magda Malcore made an unannounced visit to the facility to conduct an annual inspection. LPA's met with Rufina Laygo- Staff and discussed the purpose of the visit. At the time of the visit there were no clients and no staff at the facility.

The facility is an Adult Residential Facility (ARF) with 4 bedrooms, 5 bathrooms in the home, LPA observed kitchen/dining area, living room and a family/dining area. LPA's conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPA's inspected the facility inside and out. Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient furniture and lighting and is maintained at a comfortable temperature.

LPA's inspected the kitchen. Facility has sufficient nonperishable and perishable food for number of residents in care. Facility has a variety of food available for residents, and menus posted. Facility food is stored in a safe and healthful manner. Sharps are stored and kept locked in kitchen drawers, inaccessible to clients in care.

LPA's inspected client bedrooms. The bedrooms are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting.

LPA's inspected the bathrooms. Bathrooms were operating in a safe and sanitary conditions. The hot water temperature tested within regulation at 122 degrees F.

LPA's observed the facility is equipped with operating carbon monoxide alarms and fully charged fire extinguishers. Posters such as personal rights and the disaster plan were posted in a common area. Although there are no clients in care LPA's did observe where cleaning supplies, toxins items will be kept locked and inaccessible to clients in care.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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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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
, CA 92507

FACILITY NAME: ALBERTO CARE CENTER	FACILITY NUMBER: 361881185
	VISIT DATE: 04/13/2023

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LPA's observed were medications will be kept once residents are admitted to the facility. Medications will be in a safe and locked cabinet/closet inaccessible to clients. Facility has complete first aid kits and emergency supplies. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

There were no clients or staff files to review at the time of visit because the facility is not currently active; but LPA's were shown where staff and clients files will be located.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report LIC-809, 809-C was discussed and provided to Rufina Laygo-Staff at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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