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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366401649
Report Date: 03/02/2021
Date Signed: 03/02/2021 04:12:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501
FACILITY NAME:ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER:
366401649
ADMINISTRATOR:EVONNDA HULLFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 6DATE:
03/02/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:Program Director, Amy OsbornTIME COMPLETED:
04:10 PM
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On March 2, 2021 at 2:11pm, an unannounced virtual Post-Licensing Inspection was conducted by Licensing Program Analysts (LPA) Kendal Zirbes and Linda Haynes. A virtual inspection was conducted as a result of the Covid-19 related restrictions. During the inspection, LPA's met with Program Director Amy Osborn via FaceTime. LPA's and Program Director inspected the facility inside and out. The facility was licensed as a Short Term Residential Therapeutic Program (STRTP) on October 2, 2020. The facility is a one-story house with three bedrooms, three bathrooms, a game room, staff office, kitchen, dining area, and living room. This location also houses the facilities Children's Residential Intensive Services (CHRIS) program. The CHRIS program has a separate entrance from the facility. The office space for the CHRIS program consists of a reception area, one office space and a storage room. The facility currently has Mental Health Certification through San Bernardino County.
A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/video games/books/board games were observed for youth’s recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order. The facility maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. The facility had all required documents posted throughout the facility. Medications are locked and centrally stored in a locked filing cabinet within the locked staff office. Six individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water was measured by Precious Spence, Facility Manager. At the time of this inspection the hot water temperature was 105. The facility has a fully equipped first aid kit and first aid manual. The facility does not have cameras. At the time of this inspection, there were no bodies of water on the facility ground. Per facility staff, no firearms or weapons are allowed in the facility and smoking is prohibited. The facility vehicle was observed to be in safe operating condition and the registration was up to date Youth files are maintained in a locked filing cabinet within the staff office. Personnel Files are retained at the corporate office located at 17198 Yuma St. Suite B, Victorville CA 92395.
Report continued on page two
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 782-4833
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (951) 290-1219
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2021
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
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501
FACILITY NAME: ALPHA CONNECTION-ANOKA RANCH, THE
FACILITY NUMBER: 366401649
VISIT DATE: 03/02/2021
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Staff/client ratios were verified during this inspection and they were in accordance with the regulations. Youth and Personal files will be reviewed on a future date at the at corporate office. An exit interview was conducted with Program Director Amy Osborn. A copy of this report was emailed to the facility.
SUPERVISOR'S NAME: Christina BarnesTELEPHONE: (951) 320-2058
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (951) 290-1219
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2021
LIC809 (FAS) - (06/04)
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