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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530042
Report Date: 02/15/2023
Date Signed: 03/24/2023 01:05:14 PM

Document Has Been Signed on 03/24/2023 01:05 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:ALEXANDER CARE CENTERFACILITY NUMBER:
365530042
ADMINISTRATOR:LAYGO, ADRIANFACILITY TYPE:
737
ADDRESS:22370 VIA SECO STREETTELEPHONE:
(951) 347-0985
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 4CENSUS: 0DATE:
02/15/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adrian LaygoTIME COMPLETED:
11:10 AM
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At 10:00AM, Licensing Program Analyat (LPA) Victoria Chitgian conducted an announced visit to the facility to conduct a pre-licensing inspection. LPA met with Adrian Laygo.

Based on initial observations made by the LPA, the pre-licensing inspection is not able to be completed at this time due to the facility temperature reading of 63 degrees Farenheit. Per Licensee, heater has been on since 9:30AM, however temperature remains below regulatory standard.

LPA and licensee will reschedule a pre licensing inspection once corrections have been completed and all other elements of the pre-licensing checklist are complete.

Pre-Licensing is incomplete. A follow up Pre-Licensure LIC 809 will be generated upon completion.

An exit interview was conducted where is report was discussed and provided to Adrian Laygo.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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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