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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530042
Report Date: 07/22/2024
Date Signed: 07/22/2024 03:35:19 PM

Document Has Been Signed on 07/22/2024 03:35 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/
DIRECTOR:		LAYGO, ADRIANFACILITY TYPE:
737
ADDRESS:22370 VIA SECO STREETTELEPHONE:
(951) 347-0985
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 4CENSUS: 3DATE:
07/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Adrian Laygo - AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced Annual inspection of the facility. LPA met with Adrian Laygo, Administrator, and discussed the purpose of the visit.

The facility is a certified Inland Regional Center (IRC) vendor with a capacity of (4) and current census of (3) clients. LPA conducted an inspection of the facility, which included, but was not limited to, the following:

Operation/Physical Plant: The facility’s indoor and outdoor passageways were kept free of obstruction. Facility has no swimming pools or similar bodies of water. The facility has sufficient indoor and outdoor activity space for clients in care. The facility is maintained at a comfortable temperature. The facility is equipped with operating carbon monoxide alarms and telephone service. The facility has a sufficient supply of bed linen, towels, and emergency supplies for clients in care. Client bedrooms were equipped with beds, bed linen, chairs, storage space and sufficient lighting. Client bathroom toilets, hand washing basins and showers were in safe and sanitary operating condition. The hot water in client bathrooms tested at 115 degrees F. The facility has posted in a common area: Client personal rights, emergency telephone numbers, facility license, evacuation sketch, and Community Care Licensing Complaint poster.

Food Service: The kitchen and dining areas are maintained clean. The facility has sufficient non-perishable and perishable food supply for number of clients in care. The facility has sufficient cups, plates, and utensils for client use. Disinfectants and cleaning solutions were kept locked and store away from food areas.

Health Related Services: All client medications were labeled and centrally stored in a locked cabinet and inaccessible to clients in care. The facility has a first aid and manual.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ALEXANDER CARE CENTER
FACILITY NUMBER: 365530042
VISIT DATE: 07/22/2024
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FIle Records: Staff records audited at random had health screenings, criminal record clearances, and first aid/CPR training certifications. All client records had admission’s agreements, medical assessments, needs and service plans, Personal and Incidental logs (P&I), and personal rights. The facility has a emergency and disaster plan on file. The facility's last fire drill was conducted on 6/21/2024. The Administrator’s certification is current.

No deficiencies were cited during today’s visit. An exit interview was conducted, where this report was discussed and a copy was provided to the Administrator at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
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