365530145-2-6-2026-56-AS-LFAW-DR2QVC-20260206113007

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 365530145
Report Date: 02/06/2026
Date Signed: 02/06/2026 11:30:14 AM

Document Has Been Signed on 02/06/2026 11:30 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	SUMMERSET HORIZON		FACILITY NUMBER:	365530145
ADMINISTRATOR/ DIRECTOR:	ALCOCER, PETER		FACILITY TYPE:	735
ADDRESS:	2783 WEST SUMMERSET DRIVE		TELEPHONE:	(714) 448-0533
CITY:	RIALTO	STATE: CA	ZIP CODE:	92377
CAPACITY: 4		CENSUS: 0	DATE:	02/06/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:23 AM
MET WITH:	Michael Trujillo, Licensee and Peter K. Alcocer, Licensee		TIME VISIT/ INSPECTION COMPLETED:	11:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 2/6/2026 at 09:23 AM, Licensing Program Analyst (LPA) LaVette Farlow arrived at the facility announced to conduct a required Annual visit. LPA was greeted and granted entry into the facility by Licensee Peter K. Alcocer, and Michael Trujillo. LPA introduced self and explain the purpose of the visit. Licensee Peter stated they current are not vendorized and do not have any clients in care. LPA toured the facility inside and outside with Licensee. LPA was informed by Licensee Michael that his mother reside in the home, since they do not have clients. LPA observed that there are currently no clients admitted to the facility. The facility has 4 bedrooms, 2 bathroom, a kitchen, dining area, living room, attached 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 comfortable temperature of 73 degrees Fahrenheit. 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 cabinet in the main hallway of the residence. LPA inspected client bathroom; bathroom was clean and appliances were operating appropriately. LPA tested the water temperature in the bathroom faucet, and kitchen which tested at 125.1 and 120.5 degrees Fahrenheit. LPA advised the licensee that the temperature is out of range and to monitor the levels. The facility is equipped with operating fire extinguisher, smoke detectors and carbon monoxide alarms.

NAME OF LICENSING PROGRAM MANAGER: Nedra Brown
NAME OF LICENSING PROGRAM ANALYST: Lavette Farlow
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SUMMERSET HORIZON	FACILITY NUMBER: 365530145
	VISIT DATE: 02/06/2026

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Posters such as; the personal rights, the CCL complaint poster, 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. The facility had emergency supplies for future clients. 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 furniture for outdoor seating along with two locked sheds that had a tire and another container. Side gate with self-latching handle on the right and left side of the house that leads into the backyard. All outdoor pathways were free of obstructions.
Food Service: Non-perishable and perishable food supply is sufficient for future clients in care. Facility has a variety of food available. Dishes, cups, and utensils were also stored properly. Emergency food and water were also observed.
Record Review: LPA reviewed the facility's file along with the Administrator's file for First Aid/CPR certification, criminal record clearance, training's, and health screenings. LIcensee notified LPA that their focus is the move the License to Riverside County within the next.

No deficiencies were cited during this visit. An exit interview was conducted where this report LIC809 and LIC809-C was discussed and copies were provided to Licensee Peter Alcocer and Michael Trujillo.

NAME OF LICENSING PROGRAM MANAGER: Nedra Brown
NAME OF LICENSING PROGRAM ANALYST: Lavette Farlow
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026

LIC809 (FAS) - (06/04)

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