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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604618
Report Date: 11/05/2025
Date Signed: 11/05/2025 03:17:18 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/29/2025 and conducted by Evaluator David Roman
COMPLAINT CONTROL NUMBER: 08-AS-20251029165145
FACILITY NAME:ALPINE VIEW LODGEFACILITY NUMBER:
374604618
ADMINISTRATOR:REYNOLDS, ANGELAFACILITY TYPE:
740
ADDRESS:973 ARNOLD WAYTELEPHONE:
(626) 437-5821
CITY:ALPINESTATE: CAZIP CODE:
91901
CAPACITY:38CENSUS: 29DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Helen Qian, LicenseeTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
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9
Licensee did not report fire at facility.
INVESTIGATION FINDINGS:
1
2
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11
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13
Licensing Program Analyst (LPA), David Roman, conducted an unannounced inspection visit to initiate a complaint investigation. LPA was met by Licensee, Helen Qian and was granted entry into the facility. The purpose of the visit was discussed with Licensee.

During today's visit, LPA D. Roman along with facility staff, conducted a tour inside and outside of the facility. LPA D. Roman observed the area in which the alleged fire occurred. Staff reported that a ceiling fan was beginning to smoke, was immediately turned off, fire department contacted, and the fan was removed. LPA D. Roman took pictures of the area where the fan was located, LPA observations proved a ceiling fan malfunctioned causing smoke and no fire. Based on evidence obtained, the preponderance of evidence standard was not met, therefore, the allegation was unsubstantiated.

An exit interview was conducted with Facility Licensee, Helen Qian, to whom a copy of this report and Licensee/Appeals Rights (LIC 9058) were provided.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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