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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881185
Report Date: 07/12/2024
Date Signed: 07/12/2024 10:55:36 AM

Document Has Been Signed on 07/12/2024 10:55 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ALBERTO CARE CENTERFACILITY NUMBER:
361881185
ADMINISTRATOR/
DIRECTOR:		LAYGO, ALLISONFACILITY TYPE:
735
ADDRESS:13542 LAKOTA ROADTELEPHONE:
(760) 240-1619
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 6CENSUS: 0DATE:
07/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:22 AM
MET WITH:Adrian Laygo-StaffTIME VISIT/
INSPECTION COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA) Michelle Echeverria arrived at the facility unannounced to conduct a required Annual visit. LPA introduced self and stated the purpose of the visit to Staff, Adrian Laygo and Jayson Laygo. LPA toured the facility inside and outside with both staff. LPA observed that there are currently no clients admitted to the facility.

The facility has 4 bedrooms, 5 bathrooms, a kitchen, 2 dining areas, living room, medication area, laundry room, detached garage, and backyard. The facility is a specialized home pending vendorization by Inland Regional Center. LPA conducted a general overall inspection, which included, but was not limited to, the following:
Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a 81 degrees F temperature. LPA inspected clients bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. An adequate supply of linens stored in a closet inside the bathroom. LPA inspected client bathrooms; bathroom were clean and appliances were operating appropriately. LPA tested the water temperature which tested within regulation at 120 degrees F. The facility is equipped with operating fire extinguishers, smoke detectors and carbon monoxide alarms. Posters such as; the personal rights, visiting rules, and disaster plans were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept locked. There was a designated locked storage space for client/staff files, first aid kit and medication. There are no pools, bodies of water, firearms or ammunition. Overall, the facility is clean, in good repair, and operating in safe conditions for future clients in care.
Yards/Outside:
One shaded patio with a bbq grill and a side gate with self-latching handle on the left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. LPA observed many bees going in and out of a crack on the wall where the backyard bbq grill is located. Technical violation issued.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
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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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: ALBERTO CARE CENTER
FACILITY NUMBER: 361881185
VISIT DATE: 07/12/2024
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Food Service: Non-perishable and perishable food supply will be supplied upon clients admission. Dishes, cups, and utensils were also stored properly.

Record Review: LPA was not able to inspect the Administrator's file for First Aid/CPR certification, criminal record clearance, training's, and health screenings. Technical violation issued. The facility does not have any clients at the moment in which there are no client files to be inspected. LPA observed the Emergency disaster plan was reviewed on 7/1/24 and liability insurance expires on 7/24/24.

No deficiencies and two technical violations were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C and LIC9102TV were discussed and copies were provided to Adrian Laygo.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC809 (FAS) - (06/04)
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