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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610282
Report Date: 10/20/2022
Date Signed: 10/20/2022 03:56:53 PM

Document Has Been Signed on 10/20/2022 03:56 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PSYCLARITY HEALTH 2FACILITY NUMBER:
197610282
ADMINISTRATOR:BARSALOU, AARONFACILITY TYPE:
772
ADDRESS:4198 SUNSWEPT DRTELEPHONE:
(818) 305-4147
CITY:STUDIO CITYSTATE: CAZIP CODE:
91604
CAPACITY: 6CENSUS: 0DATE:
10/20/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Robert YoungTIME COMPLETED:
04:05 PM
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At 1:45 p.m. on 10/20/2022 Licensing Program Analyst (LPA) Nicholas Reed conducted an announced prelicensing visit. LPA met with staff and disclosed the reason for the visit. LPA and staff toured the facility inside and out.

It is a three story building with 3 bedrooms, 4 bathrooms, kitchen, garage, common areas, offices, and outdoor areas. It has an approved fire clearance for 6 ambulatory residents. The facility uses surveillance cameras at the exterior and in common areas. LPA observed postings for the Joint Commission certification and CDPH certification at the front.

The first floor contained a therapy room, emergency supply closet, staff bathroom, elevator, and locked garage area. The garage contained locked cabinets for sharps and cleaners. Laundry machines in working condition were located in the locked garage along with emergency water supplies. At 2:01 p.m. LPA measured the room temperature to be 72 degrees Fahrenheit. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair.

The second floor contained a therapy office, kitchen, group room, living room, meditation area, and outdoor patio access. Kitchen appliances were operable. Surfaces were sanitary and odorless. Staff supervise kitchen activities and sharp object use. LPA observed an adequate supply of perishable and non-perishable food. A daily temperature log was posted on the side of the refrigerator. The last reading showed 36 and -7 degrees Fahrenheit for the refrigerator and freezer, respectively. An activity schedule was posted near the living room. The living room contained a television, video games, and an appropriately covered fireplace. The group room contained reading materials, board games, an additional refrigerator, socially distant furniture, instruments, and a computer. The outdoor patio area contained workout equipment, leisure activities, a gas grill, and covered patio furniture in good condition.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PSYCLARITY HEALTH 2
FACILITY NUMBER: 197610282
VISIT DATE: 10/20/2022
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The facility had 3 bedrooms. Bedroom #1 had 3 beds. LPA requested an exception from the licensee to maintain on file for 3 residents staying in the same bedroom. Bedroom #2 had 2 beds which were socially distanced. Bedroom #3 was a private bedroom. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition.

The facility had 4 bathrooms. All bathrooms contained liquid soap, paper towels, and a trash can with a tight fitting lid. At 2:14 p.m. LPA measured the water temperature in the bathroom private to Bedroom #1 to be 123.1 degrees Fahrenheit. Signs were posted at each sink stating “Caution: Very Hot Water”

All emergency exit paths were free from obstructions. Exit gates were unlocked. Fire extinguishers were located on all three levels. At 2:05 p.m. LPA observed a fully charged fire extinguisher near the living room. It was last inspected on 12/09/2021. Facility sketches were posted throughout the facility. Evacuation routes clearly were labeled on the sketches. At 2:17 p.m. LPA tested the third floor carbon monoxide detector to be operational. At 2:20 p.m. LPA tested the third floor smoke detector to be operational.

The facility had an incomplete First Aid Kit. Required postings were not present. A COVID screening station must be implemented too.

Pre-Licensing is incomplete with deficiencies to be resolved by 10/27/2022. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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