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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604618
Report Date: 12/02/2022
Date Signed: 12/02/2022 10:21:11 AM


Document Has Been Signed on 12/02/2022 10:21 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:ALPINE VIEW LODGEFACILITY NUMBER:
374604618
ADMINISTRATOR:QIAN, HELENFACILITY TYPE:
740
ADDRESS:973 ARNOLD WAYTELEPHONE:
(626) 437-5821
CITY:ALPINESTATE: CAZIP CODE:
91901
CAPACITY:38CENSUS: 0DATE:
12/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Administrator Helen Qian, Vanessa Ricchiazzi, Angela Reynolds, and Linda CioffiTIME COMPLETED:
10:25 AM
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Licensing Program Analysts (LPAs) Tammer De Los Santos and Kayla Hilario conducted an announced Pre-Licensing inspection. LPAs identified themselves, discussed the purpose of the visit, and met with Administrator Helen Qian, Vanessa Ricchiazzi, Angela Reynolds, and Linda Cioffi. .

LPA conducted a tour of the facility, both inside and outside. There are no pools on site. The smoke and carbon monoxide alarms were present. Toilets intended for resident use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, blinds and paint throughout the facility, was observed in good condition. Each room intended for resident use had the appropriate furniture, bedding and appropriate lighting. Administrator Qian stated there are no firearms stored on the premises.

Hot water temperature was measured in the facility at 117.0 degrees F. The ambient temperature inside the facility was measured with at 73 degrees F. The facility was observed to be clean and kempt with no strong malodors. The refrigerators and freezers were observed to be clean and operational, with an ample amount of food to meet client needs. Cleaning solutions were also properly secured.

The Component III portion of the application process was completed with on Qian on today's date as well. Once license is obtained, all facility staff will be associated.

Pre-Licensing is complete and this facility has no deficiencies. An exit interview was conducted with Administrator Helen Qian. The Applicant was provided with a copy of this report and Appeal/Licensee rights (LIC9058 03/2022) via hardcopy at the conclusion of the visit.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Kayla HilarioTELEPHONE: 619-481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/02/2022
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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