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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610282
Report Date: 10/27/2022
Date Signed: 10/27/2022 02:11:42 PM

Document Has Been Signed on 10/27/2022 02:11 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:
10/27/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Robert YoungTIME COMPLETED:
02:20 PM
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At 2:00 p.m. on 10/27/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an announced subsequent prelicensing inspection to correct previous deficiencies. LPA met with staff and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

LPA observed required facility postings at the main entrance, COVID screening station, and complete First Aid kit.

Pre-Licensing deficiencies have been resolved. Pre-Licensing is now complete.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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