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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881253
Report Date: 05/16/2022
Date Signed: 05/16/2022 11:03:17 AM

Document Has Been Signed on 05/16/2022 11:03 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:ALRU CARE CENTERFACILITY NUMBER:
361881253
ADMINISTRATOR:LAYGO, ARCELIAFACILITY TYPE:
735
ADDRESS:1329 ALRU STREETTELEPHONE:
(909) 275-8805
CITY:BLOOMINGTONSTATE: CAZIP CODE:
92316
CAPACITY: 4CENSUS: 0DATE:
05/16/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Arcelia Laygo, LicenseeTIME COMPLETED:
11:05 AM
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Licensing Program Analyst (LPA) Anna Bueno made an announced visit to the facility in order to conduct a pre-licensing inspection for a change of ownership application.. LPA Bueno identified herself to licensee, Arcelia Laygo, and Cielita Ravelo, operations assistant, and advised them of the purpose of the visit.

The facility is currently licensed as an Adult Residential Facility. The facility has been granted a fire clearance on 3/25/2022 by the San Bernardino County Fire Department for a total capacity of four ambulatory clients.

The facility has a total of five bedrooms, four of which are for clients, two bathrooms, one of which are clients, a kitchen and dining area, a living room, two activity areas, and backyard. LPA and Licensee toured the interior and exterior of the facility. The facility has no bodies of water. There is a shaded seating area for clients. LPA observed that side gates were unlocked and free of obstruction. The facility had a working telephone for client use. The facility has charged fire extinguishers, and operating smoke alarms and carbon monoxide detectors. The facility had a complete first aid kit and manual. A locked centralized storage area for medications and client files were observed. The following were observed of the physical plant:

Client Bedrooms: LPA observed all bedrooms to have the required bedding and furniture, such as, clean mattresses/linen, sufficient storage space, chairs, and lighting.
Client Bathrooms: LPA observed bathroom appliances were operating in safe and sanitary conditions and contained appropriate hygiene items for clients.
Kitchen and Dining Area: LPA inspected the kitchen and found cleaning supplies and sharps were kept in a safe and secured place. Dishes, glasses, and utensils were in good
condition and stored in a safe manner. LPA observed two (2) days supply of perishable ***
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022
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 2
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: ALRU CARE CENTER
FACILITY NUMBER: 361881253
VISIT DATE: 05/16/2022
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***food items and seven (7) days supply of nonperishable food items. The facility menu was available for review. The kitchen countertop, floors, and appliances were free from debris.
Common (living/activity) areas: LPA observed adequate seating in common areas. The facility had a supply of activities for the clients.

LPA observed that the physical plant is clean, in good repair, and appear to be hazard-free during today's visit. LPA has determined that the facility is meeting operational requirements for current clients. No corrections are needed to be made. COMP III was waived as Licensee has several other licensed facilities in good standing.

An exit interview was conducted where this report was discussed and a copy was provided to Arcelia Laygo and Cielita Ravelo at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC809 (FAS) - (06/04)
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