<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004524
Report Date: 06/01/2026
Date Signed: 06/01/2026 01:42:31 PM

Document Has Been Signed on 06/01/2026 01:42 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ALPINE B II CAREFACILITY NUMBER:
306004524
ADMINISTRATOR/
DIRECTOR:		KAHDIJA"HEIDI"BAHAFACILITY TYPE:
740
ADDRESS:26352 PAPAGAYO DRIVETELEPHONE:
(949) 454-8349
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 5DATE:
06/01/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Heidi Baha- AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Yessica Avila after introducing self and stating the reason for the visit. Administrator Heidi Baha arrived on premise to assist with the inspection. Administrator Baha has a valid certificate expiring March 1, 2027.

The following was observed during the inspection: The facility is located in a residential neighborhood comprised of four private resident bedrooms, one shared resident bedroom, five half resident bathrooms, one full resident bathroom, and one shared caregiver's bedroom. LPA observed five residents in care, two of which are on hospice. LPA observed two staff on duty. Facility is operating within the conditions and limitations specified on the license. LPA toured the physical plant with Administrator. LPA inspected all bedrooms, common areas including the attached two car garage. The resident bedrooms' were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. Facility appeared clean and sanitary including all bathrooms. However, the following areas were observed to be in disrepair: the locking mechanism for the medication cabinet did not lock properly and the left faucet handle was in disrepair in Bedroom #3. Admin stated that Resident #2 (R2) utilizes the shower room across R2's bedroom. Slip resistant mats were observed to be available in the bathrooms. The hot water temperature in the resident bathrooms were below range, measuring at 96.6, 96.0, 91.5, 82.0, and 81.6 degrees Fahrenheit. Toxins, disinfectants, and sharps were secured, however medications in the grey cabinet were not secured and made accessible.
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jessica Cho
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 10
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 10
Document Has Been Signed on 06/01/2026 01:42 PM - It Cannot Be Edited


Created By: Jessica Cho On 06/01/2026 at 12:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ALPINE B II CARE
FACILITY NUMBER: 306004524

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.618(c)(3)
Other Provisions
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview, the licensee did not comply with the section cited above in two of two staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
1
2
3
4
Admin to forward proof to LPA via email by POC due date. Please ensure at least one staff on duty is CPR/First aid certified effective immediately.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Jessica Cho
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2026


LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 06/01/2026 01:42 PM - It Cannot Be Edited


Created By: Jessica Cho On 06/01/2026 at 12:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ALPINE B II CARE
FACILITY NUMBER: 306004524

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(f)
Personnel Requirements - General
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in one of two staff (S1) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
1
2
3
4
Admin to forward proof of TB test for S1 to LPA via email by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Jessica Cho
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2026


LIC809 (FAS) - (06/04)
Page: 4 of 10
Document Has Been Signed on 06/01/2026 01:42 PM - It Cannot Be Edited


Created By: Jessica Cho On 06/01/2026 at 12:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ALPINE B II CARE
FACILITY NUMBER: 306004524

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in one of two staff (S1) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
1
2
3
4
Admin to forward proof to LPA via email by POC due date. Refer to LIC859.
Type B
Section Cited
CCR
87458(c)(1)(A)
Medical Assessment
(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in one of five residents (R4) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
1
2
3
4
Admin to forward proof of TB test for R4 to LPA via email by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Jessica Cho
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2026


LIC809 (FAS) - (06/04)
Page: 5 of 10
Document Has Been Signed on 06/01/2026 01:42 PM - It Cannot Be Edited


Created By: Jessica Cho On 06/01/2026 at 12:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ALPINE B II CARE
FACILITY NUMBER: 306004524

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in six of six bathrooms which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/02/2026
Plan of Correction
1
2
3
4
Admin to ensure the hot water temperature meets within range of 105-120 and to forward proof of a hot water temperature log that will be implemented weekly by POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Jessica Cho
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2026


LIC809 (FAS) - (06/04)
Page: 9 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ALPINE B II CARE
FACILITY NUMBER: 306004524
VISIT DATE: 06/01/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA observed one tablet in a pill organizer on top of a wooden cabinet and medications that require refrigeration were made accessible as Admin indicated that Resident #5 (R5) accesses the refrigerator in the evenings. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction, and there are sufficient seating and shading. LPA observed two exit gates that were operable. The first aid kit contains all necessary elements. The two fire extinguishers were mounted, charged, and serviced on January 21, 2026. The auditory devices and smoke/carbon monoxide detectors were tested and operational in all areas. Facility maintains emergency food and water. A working telephone number (949) 454-8349 was tested and remains available. Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the entry way in the correct size.

LPA reviewed five residents and two personnel files. Discrepancies noted for both resident/staff files. Licensee did not maintain a complete record for four residents (R1-R4) and one staff (S1) and one of five residents (R4) and one of two staff (S1) did not receive a Tuberculosis (TB) testing. Present staff are background cleared and associated to the facility. One of two staff (S1) did not meet their initial 40 hour training where 6 of the 20 hour dementia care training is completed before employment. Additionally, both staff are not CPR/First Aid certified. Admin to forward proof of certificate as per Admin training was completed May 29, 2026. The Emergency Disaster Plan (LIC610E) was reviewed. Disaster drills of various scenarios are conducted quarterly with the last date for earthquake drill was conducted March 13, 2026. Medications were audited for two of five residents. Discrepancies noted as the medication list in review of two residents were not up-to-date. Admin will provide an order for R5 for ACJ Joint spray.

The following was consulted: to repair the locking mechanism for the medication cabinet immediately, to repair the left faucet handle in the bathroom of Bedroom #3, to ensure medications always remains secured and inaccessible, to ensure hot water measures within a comfortable range of 105 to 120 degrees Fahrenheit, to maintain complete records for residents and staff, to ensure one resident and staff completes their TB testing, to ensure staff meets their required training hours, to ensure at least one staff on duty is CPR/First Aid certified, and to ensure the medication list is current and up-to-date.

Based on the observations made during today's visit, deficiencies are being cited, and Advisory Notes are being issued. An exit interview was conducted with Administrator Heidi Baha, and a copy of this report including the appeal rights were provided at exit.
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Jessica Cho
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026
LIC809 (FAS) - (06/04)
Page: 10 of 10