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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366401649
Report Date: 03/26/2024
Date Signed: 03/27/2024 08:58:58 AM


Document Has Been Signed on 03/27/2024 08:58 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
RIVERSIDE CRP RO, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501



FACILITY NAME:ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER:
366401649
ADMINISTRATOR:EVONNDA HULLFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 5DATE:
03/26/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Evonnda Hull TIME COMPLETED:
12:30 PM
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On March 26, 2024, Licensing Program Analyst (LPA) Daniel Mena arrived at Alpha Connection- Group Home (GH). LPA Mena was granted access by Administrator, Evonda Hull. The purpose of the visit is to conduct an annual inspection of the facility. Administrator led the physical inspection of the facility with LPA Mena.

A physical plant inspection was completed and included the facility’s visitor's room, living room, kitchen area, dinning area, office, therapist office area, refrigerator/freezers, food storage areas, 3 client bedrooms, front and backyard areas, and 3 bathroom/showers. Facility grounds are clean and free of debris and observable hazards.

Sports equipment/toys/books/games/computers were observed for children’s recreation time. There is adequate indoor and outdoor activity space. Facility smoke detectors and carbon monoxide detectors are in working order; fire extinguisher is properly charged and serviced. Licensee maintain an adequate supply of perishable and non-perishable foods and the menus were posted. All other required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsperson poster. Medications are to be locked and centrally stored inside staff's office. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. Hot water temperature was measured. Per the Administrator, no firearms or weapons are allowed in the facility.

The facility has a visitor's room, living room, kitchen area, dinning area, office, therapist office area, laundry room, food storage areas, 3 client bedrooms, and 3 bathroom/showers. All bedrooms have individual beds and drawer space for each client. The facility ensures that there is one client per bed with appropriate linens, pillows, comforters, and mattresses in good repair.

CONTINUES on LIC 809C

SUPERVISOR'S NAME: Jennifer SmithTELEPHONE: (951) 782-4969
LICENSING EVALUATOR NAME: Daniel MenaTELEPHONE: (323) 981-3386
LICENSING EVALUATOR SIGNATURE:
DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2024
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
RIVERSIDE CRP RO, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501
FACILITY NAME: ALPHA CONNECTION-ANOKA RANCH, THE
FACILITY NUMBER: 366401649
VISIT DATE: 03/26/2024
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Chemicals and/or poisons, sharp objects/knives are locked in a file cabinet in the staff office. First Aid Kits are stored in a locked cabinet in the staff office. LPA reviewed the facility's disaster plan.

The facility currently has two children, each in their own bedroom. The facility must ensure that each client is aware of the bedroom sharing policy and document the advisement in the clients’ files. Based on record review, the facility did provide a signed bedroom sharing document in their files. There are currently several children taking prescribed medications.
There were no deficiencies/corrections observed on this date.


An exit interview was conducted and a copy of this report were provided to Administrator.
SUPERVISOR'S NAME: Jennifer SmithTELEPHONE: (951) 782-4969
LICENSING EVALUATOR NAME: Daniel MenaTELEPHONE: (323) 981-3386
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
LIC809 (FAS) - (06/04)
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