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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320074
Report Date: 06/23/2024
Date Signed: 06/23/2024 04:11:05 PM

Document Has Been Signed on 06/23/2024 04:11 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:CLEARVIEW TREATMENT PROGRAMSFACILITY NUMBER:
198320074
ADMINISTRATOR/
DIRECTOR:		GHERNA, ELIZABETHFACILITY TYPE:
772
ADDRESS:2616 GRANDVIEW AVENUETELEPHONE:
(310) 344-5134
CITY:VENICESTATE: CAZIP CODE:
90291
CAPACITY: 6CENSUS: 5DATE:
06/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Carter Serrett/CEOTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 6/23/2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Carter Serrett /CEO. LPA explained the purpose of today’s visit. The facility is licensed as short-term crisis residential treatment program for (6) ambulatory only.

The facility is a two-story structure located in a residential neighborhood. It consists of the following: 6 bedrooms, 6 1/2 bathrooms, office, living room, kitchen, dining room, activities room, shaded area, indoor and outdoor activity area, laundry room and attached 2 car garage.



LPA Iniguez and the CEO toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (4) bedrooms and (4) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 113.5°F to 116.2°F, and the room temperature ranged from 76°F to 78°F.

The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2024
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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CLEARVIEW TREATMENT PROGRAMS
FACILITY NUMBER: 198320074
VISIT DATE: 06/23/2024
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During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to clients in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 7/11/24.

A review of (4) clients' service files and (3) staff personnel files was maintained in order. LPA reviewed (3) Medication Administration Records (MAR)’s No discrepancies were found.

LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance was emailed to LPA. Facility Annual Fees not current. LPA Iniguez provided PIN # 725559 to CEO Carter Serret and pay fees online.

Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 8. See details below:

-Facility License not posted on a prominent, publicly accessible location at the facility.

Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. *


An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Carter Serret / CEO.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/23/2024 04:11 PM - It Cannot Be Edited


Created By: Alfonso Iniguez On 06/23/2024 at 04:00 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
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CLEARVIEW TREATMENT PROGRAMS
FACILITY NUMBER: 198320074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
81009(a)
81009 Posting of License

(a) The license shall be posted in a prominent, publicly accessible location in the facility.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) , the licensee did not comply with the section cited above in not having the CDSS license posted at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2024
Plan of Correction
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Licensee will ensure license is posted at all times. As plan of correction, licensee will ensure facility license is posted in a public area. Licensee cleared citation by posting the license while LPA Iniguez was conducting annual evalaution.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Eva M Alvarez
LICENSING EVALUATOR NAME:Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2024


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