197610282-2-12-2025-31-AS-NSHN-DDU2HS-20250212162514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610282
Report Date: 02/12/2025
Date Signed: 02/12/2025 04:25:35 PM

Document Has Been Signed on 02/12/2025 04:25 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	PSYCLARITY HEALTH 2		FACILITY NUMBER:	197610282
ADMINISTRATOR/ DIRECTOR:	BARSALOU, AARON		FACILITY TYPE:	772
ADDRESS:	4198 SUNSWEPT DR		TELEPHONE:	(818) 305-4147
CITY:	STUDIO CITY	STATE: CA	ZIP CODE:	91604
CAPACITY: 6		CENSUS: 5	DATE:	02/12/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Robert Young / Director of Compliance		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

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Licensing Program Analysts (LPA) Nadia Shahbazian and Evelin Rios conducted an unannounced Annual Required visit. LPAs met with staff at 10:00 AM and the staff contacted Robert Young/Director of Compliance and explained the reason for the visit.

Facility is a three story building with 3 bedrooms, 4 bathrooms, kitchen, garage, common areas, offices, and patio areas. It has an approved fire clearance for 6 ambulatory residents. Current census is five (5) consumers. The facility uses surveillance cameras at the exterior and in common areas. LPA observed required postings at the front entry.

At approximately 10:30 am, with the assistance of the Director of Compliance, LPAs took a tour of the physical plant. The first floor contained the garage which is currently used as a garage/office. Supply closet, staff bathroom, elevator, and an extra room/office was observed on the first floor. LPAs observed an "out of order" sign on the elevator and the Director of Compliance stated that elevator has been out of service for over one (1) year. Maintenance Manager tried to repair the elevator initially and later contacted several elevator mechanics with no success. Director of Compliance will try to have the elevator repaired as soon as possible. The garage contained locked cabinets for sharp objects, cleaning supplies, locked medication cabinet and emergency water supplies. Two (2) complete first aid kits and first aid manual were kept in locked garage cabinets. Laundry room was located near the garage with laundry machines in working condition. Detergents and chemicals were observed to be locked in the laundry room.

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SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PSYCLARITY HEALTH 2	FACILITY NUMBER: 197610282
	VISIT DATE: 02/12/2025

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Smoke detector and the monoxide carbon detectors are interconnected. At 11:06 am LPAs tested the second and third floor smoke and monoxide detectors and observed them to be operating properly. The facility has functional sprinklers installed in every room. The pull switch for the smoke alarm were also observed near the entrance. There are several fire extinguishers located throughout the facility, with a charge date of 11/27/2024. The last fire and emergency drill was conducted on 01/30/2025. Facility sketches were posted throughout the facility. Evacuation routes clearly were labeled on the sketches. There are three exists, one at the front door, one at the back patio and one on the bedroom #3 on the third floor, which led down to the outside area. All emergency exit paths were free from obstructions and exit gates were unlocked.

The second floor contained a kitchen, dining/group room, two (2) living rooms, one of which is used as entertainment area. The second floor also includes the therapist's office and outdoor patio access. All the common area rooms were observed to have ample seating for the facility residents and staff and furniture was observed to be in good condition. The living room contained a television, video games, and a screened covered fireplace. The group room contained reading materials, board games, instruments and a computer. Kitchen appliances were operable and clean. Kitchen surfaces were sanitary and clean. The facility only prepares breakfast; lunch and dinner are catered daily from an outside vendor. All sharp kitchen objects were kept locked in the office on the first floor. LPA observed an adequate supply of perishable and non-perishable foods and ample supply of kitchen dishes.

The facility has 3 bedrooms. Bedroom #1 had 3 beds and an exception was requested. Bedroom #2 had 2 beds with a private bath room. Bedroom #3 was a private bedroom with its own bathroom. All bedrooms contained a chair, ample lighting, storage, and bedding. All furnishings were clean and in good condition. The carpets in the bedrooms had stains and require cleaning or replacement.

The facility had 4 bathrooms. All bathrooms contained liquid soap, paper towels, and a trash can with a tight fitting lid. LPA measured the water temperature in the bathroom private to Bedroom #1 to be 122.1 degrees Fahrenheit. Signs were posted at each sink stating “Caution: Very Hot Water

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SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PSYCLARITY HEALTH 2	FACILITY NUMBER: 197610282
	VISIT DATE: 02/12/2025

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Medications: LPAS observed the medications in a locked cabinet in the garage/staff breakroom. Medications for two consumers were counted and verified that medication were properly administered.

Staff files: LPAs reviewed staff files to ensure staff has fingerprint clearance, association to the facility, and current 1st Aid, CPR, and Crises Prevention Intervention (CPI) certification.

Client files: LPAs reviewed client records to ensure their files include medical assessments, appraisals or individual program plan, emergency contact information, and admission agreements.

Pursuant to Title 22 Divisions the CA Code of Regulations, there were couple of technical violations observed during the visit, which will be addressed by the licensee. Exit Interview Conducted and a Copy of the Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC809 (FAS) - (06/04)

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