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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366402331
Report Date: 03/21/2025
Date Signed: 03/24/2025 12:38:50 PM

Document Has Been Signed on 03/24/2025 12:38 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
RIVERSIDE N CRP RO, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501
FACILITY NAME:ALPHA CONNECTION-SHOSHONEE PLACE, THEFACILITY NUMBER:
366402331
ADMINISTRATOR/
DIRECTOR:		ANTHONY RILEYFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6CENSUS: 3DATE:
03/21/2025
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Amy OsbornTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On March 21, 2025, Licensing Program Analysts (LPAs) Daniel Mena and Raina Perez-Diaz arrived at Alpha Connection- Group Home (GH). LPA Mena was granted access by and Facility Staff, Hadley Flanders. The purpose of the visit is to conduct an annual required inspection of the facility. Program Director, Amy Osborn, led the physical inspection of the facility with LPA Mena.

A physical plant inspection was completed and included the facility’s visitor's room, common area, kitchen area, refrigerator/freezers, food storage areas, client bedrooms, bathroom/showers and garage. 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 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. Facility Manager stated that water was adjusted at time of visit Per the Administrator, no firearms or weapons are allowed in the facility.

CONTINUES on LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Nicole Strickland
NAME OF LICENSING PROGRAM ANALYST: Daniel Mena
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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 N CRP RO, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501
FACILITY NAME: ALPHA CONNECTION-SHOSHONEE PLACE, THE
FACILITY NUMBER: 366402331
VISIT DATE: 03/21/2025
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The facility has a dining area, kitchen area, living room, open common area/formal living room, an office, and a room where the washer and dryer are located. 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. During visit LPA Mena observed employee repairing a damaged window screen.

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 three children placed 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. LPA Reviewed client's medication and medication logs. There were no deficiencies/corrections observed on this date.


An exit interview was conducted and a copy of this report were provided to Program Director.
NAME OF LICENSING PROGRAM MANAGER: Nicole Strickland
NAME OF LICENSING PROGRAM ANALYST: Daniel Mena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC809 (FAS) - (06/04)
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