Alpine Board and Care

Type of visit: Required - 1 Year

On June 29 2026 at 10:15 a.m. Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with care staff who phoned the administrator China Washington acting for Alex Novell (cert #6065982740 exp: 02-24-27) and explained the purpose of the visit. Administrator certificate is current. The administrator arrived at about 11:30a.m. LPA Benson and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to six (6) resident rooms, common areas, six (6) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. Medications were also reviewed. Medication is locked in a locked file. The common area was clean, odor-free and in good repair. All bedrooms had required furniture, lighting and windows with screens. The bathrooms were clean and in good repair. The kitchen was clean and in good repair. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. There is a schedule of activities planned for the clients. All required postings are displayed within the facility. No pools/bodies of water are on the premises. No firearms are on premises. The last disaster drill was conducted and documented on 03-03-26, the facility has been conducting drills every 3 months. LPA interviewed four resident and two staff. The following deficiencies were observed (See LIC 809D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted, a copy of the report, and appeal rights provided to administrator.the state’s words, verbatim · CDSS document, Jun 29, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, China Washington, to conduct a case management health and safety check. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and five (5) bathrooms for resident use, along with one (1) bedroom and one (1) bathroom for staff. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on site. Hot water temperature was observed to be 113 degrees F. LPA reviewed three (3) residents' medications and observed medication storage to be locked away and inaccessible to the residents. LPA reviewed six (6) resident records and one (1) staff record. LPA observed staff on the premises to have a criminal background clearance on file. As a result of today's inspection, no deficiencies are being cited. Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 15, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with caregiver, Ruzanna Sargsyan, to conduct a case management health and safety check. LPA spoke with Administrator, China Washington, via telephone call, who gave permission to have caregiver sign report. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and five (5) bathrooms for resident use, along with one (1) bedroom and one (1) bathroom for staff. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. Hot water temperature was observed to be 115 degrees F. LPA reviewed five (5) resident records and two (2) staff records. LPA observed staff on the premises to have a criminal background clearance on file. As a result of today's inspection, no deficiencies are being cited. Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Oct 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 6/18/25 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and five (5) bathrooms for resident use, along with one (1) bedroom and one (1) bathroom for staff. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 120 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA reviewed two (2) residents' medications and observed medication storage to be locked away and inaccessible to the residents. LPA reviewed four (4) resident files and two (2) staff files. Facility has a current copy of certificate of liability insurance and LPA requested a copy. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit was interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Jun 18, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with caregiver, Shanique Naulty, to conduct a case management health and safety check. LPA spoke with Administrator, China Washington, via telephone call, who gave permission to have caregiver sign report. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and five (5) bathrooms for resident use, along with one (1) bedroom and one (1) bathroom for staff. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. Hot water temperature was observed to be 118.3 degrees F. LPA reviewed four (4) resident records and two (2) staff records. LPA observed staff on the premises to have a criminal background clearance on file. As a result of today's inspection, no deficiencies are being cited. Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 21, 2025

Type of visit: Office

An informal conference was conducted at 7:30am on June 20, 2024, with Sacramento North Regional Office via Microsoft Teams. The purpose of this informal conference meeting is to address citations issued during inspection conducted on 5/20/2024. The Administrators were told that this Informal conference is a part of the Administrative Action process and that further noncompliance may result in an elevation to a formal noncompliance conference, which could lead to a referral to the Department's legal division for possible revocation of license. The following Licensing staff were present: Licensing Program Analyst (LPA) Michael Hood and Licensing Program Manager (LPM) Anthony Perez The following facility representatives were present: Administrators Alex Novell and China Washington The following topics were covered during today's meeting: · An overview regarding 3 Type A citations, 2 substantiated complaint allegations, and 1 civil penalty · Care and supervision, including on-call night supervision during NOC shift and Administrator presence at the facility. Administrators are working on pending corrections that will be completed and submitted to LPA by 6/27/2024. Facility was notified that the Department may increase monitoring at the facility. Technical support was offered to facility representatives during meeting. An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy must be signed and returned to the Department.the state’s words, verbatim · CDSS document, Jun 20, 2024

Allegation investigated: Facility issued an unlawful eviction

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Alex Novell, to open a complaint into the allegation listed above. During today's visit, LPA interviewed Licensee and Administrator, China Washington, and reviewed documentation pertinent to the investigation. LPA reviewed a text authored by Licensee and issued to resident (R1's) responsible party (RP) stating regarding to the text to "consider it as a 30 day notice to take [R1] somewhere else." LPA observed a text authored by Administrator and sent to R1's RP stating to "disregard the 30 day notice." Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted with Licensee. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Substantiatedthe state’s words, verbatim · CDSS document, May 20, 2024 · control 59-AS-20240517152244

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.683(a) · Plan of correction due date: Jun 9, 2024

§1569.683 Eviction notices; reasons for eviction contents; service (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. (...) This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not issue a lawful 30-day notice to R1's representative regarding eviction, which poses an potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 20, 2024

Plan of correction: Facility will complete a statement of understanding regarding regulation 1269.683. Facility will submit statement of understanding to LPA by POC due date of 6/09/2024.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 5/20/24 to conduct an annual continuation visit utilizing the inspection tool following the Required-1 Year Inspection conducted on 5/15/2024. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and five (5) bathrooms for resident use, along with one (1) bedroom and one (1) bathroom for staff. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 120 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA checked medication storage and found medication to be locked away and inaccessible to the residents. LPA reviewed two (2) resident files and five (5) staff files during today's visit. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. A civil penalty in the amount of $500 is being assessed today due a one (1) staff member not receiving a criminal background clearance. Deficiencies are listed on 809-D. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 20, 2024

Allegation investigated: Staff are not providing adequate food service to residents

Licensing Program Analysts (LPA) Michael Hood arrived at the facility and met with Administrator, Alex Novell, to deliver findings into the allegation listed above. During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: ** Report continued on 9099-C ** Substantiated During visit conducted on 11/29/2023, LPA conducted an inspection of the facility's required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed multiple open containers, including salad dressing, and multiple expired food items, including yogurt and condiments, in the facility's refrigerator. LPA also observed multiple food containers with prepared food that was not dated or labeled. LPA observed staff member (S1) clean refrigerator and purge expired food items during visit conducted on 11/29/2023. During all subsequent visits to the facility during investigation, LPA observed a sufficient supply of food at the facility. Based on observation, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Interview with relevant party indicated that resident (R1) sustained a burn while residing at the facility. Interviews conducted with Administrator, China Washington, and staff members (S1 & S2) indicated that they never observed R1 sustain a burn mark while residing at the facility. LPA conducted an interview with R1, who could not recall sustaining a burn while residing at the facility. LPA did no observe a burn mark on R1 during interview. A review of R1's hospice records dated 10/1/2023 to 12/12/2023 did not indicate that R1 sustained a burn mark during the time that they resided at the facility. Interview with relevant party indicated that they could not recall requesting documents for R1. Interview with Administrator Washington indicated that any records requested for R1 were provided to the requester within a timely manner. Interview with relevant party indicated that they were allowed to visit R1 while they resided at the facility. Interviews with Administrator Washington, staff members S1, S2, S3, and S4 stated that they are allowing visitation at the facility. All staff interviews indicated that there is a visitor policy allowing visitation between 9:00 AM to 5:00 PM everyday, but accommodations are made for individuals who cannot visit residents during those hours. Interviews with residents R2, R3, and R4 indicated that they are able to receive visitors at the facility. LPA observed a visitor log for visitors to sign at the conclusion of this investigation. Interview with relevant party indicated that activities were not provided to R1 in accordance with their admission agreement. LPA reviewed R1's Admission Agreement, which indicates the following: "We shall offer individualized program of recreational activities based on cooperative planning by facility staff, family, physician, and rapport and communication with the resident. We offer responsive, creative, and fluid planning of recreational activities. Residents and families are interviewed to gather information on their personal preferences, beliefs, culture, values, attention span and life experiences to determine activities that residents will enjoy and benefit from." LPA observed that admission agreement was signed by R1's representative on 10/11/2023. ** Report continued on 9099-C ** During visit conducted on 11/29/2023, LPA observed board games, crossword puzzles, and toys available to the residents. LPA observed books and a television in the residents' rooms. Interviews conducted with Administrator Washington, S1, S2, S3, and S4 indicated that the residents are provide resources for activities and encouraged to participate in activities. Interviews with residents R2, R3, and R4 indicated that they have resources for activities Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 15, 2024 · control 59-AS-20231122112651

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8) · Plan of correction due date: May 31, 2024

87555 General Food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality. (...) Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Based on observation, facility did not ensure food items were of good quality and stored in sealed containers, which poses a potential health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 15, 2024

Plan of correction: Facility purged food items during visit conducted on 11/29/2023. LPA observed a sufficient supply of food of good quality during all subsequent visits. LPA cleared deficiency at the conclusion of this investigation.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 5/15/24 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA interviewed two (2) residents during inspection. LPA reviewed three (3) resident files and one (1) staff file. Facility has a current copy of certificate of liability insurance and LPA obtained a copy. As a result of today's visit, no deficiencies were cited per California Code of Regulations, Title 22. LPA will return at a later time to complete annual inspection. Exit interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, May 15, 2024

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Michael Hood arrived at the care home unannounced on 1/9/24 to conduct a post licensing visit. A complete tour of the facility was conducted and there are currently two (2) residents in care. There are six (6) bedrooms and five (5) bathrooms for resident use, along with one (1) bedroom and one (1) bathroom for staff. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. LPA observed that there are locked cabinets for knives and medications. LPA checked the kitchen area for the ability to prepare and store food. Care home has the required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed the backyard and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. First aid kit to be maintained and ready for emergency use. Smoke detectors and carbon monoxide detectors are hard wired and functioning. No deficiencies were cited at today's visit. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Jan 9, 2024