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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320088
Report Date: 11/30/2022
Date Signed: 12/08/2022 10:44:05 AM

Document Has Been Signed on 12/08/2022 10:44 AM - 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CLEARVIEW TREATMENT PROGRAMFACILITY NUMBER:
198320088
ADMINISTRATOR:GHERNA, ELIZABETHFACILITY TYPE:
735
ADDRESS:2474 GLYNDON AVENUETELEPHONE:
(310) 344-5134
CITY:VENICESTATE: CAZIP CODE:
90291
CAPACITY: 6CENSUS: 5DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Leilani Le, AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual inspection visit and infection control inspection to the above facility. LPA was met with Leilani Le, Administrator and the purpose of today’s visit was explained.

There are currently (5) client at the facility. (5) clients are ambulatory. (0) non-ambulatory. The facility is a two-story structure located in a residential neighborhood. It consists of the following: 3 bedrooms, 3 1/2 bathrooms, family room, office, living room, kitchen, dining room, shaded area in front porch and back porch, outdoor activity area, laundry room, back staircase outside, and a 2 car detached garage.

LPA and Compliance Coordinator toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. Bedrooms 1 - 3 are occupied by clients and contain the mandated furniture. The (3 1/2) bathrooms are clean and operational. Smoke detectors and carbon monoxide detector comply and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. 1 staff file is current, 1 resident file is current along with medications. The water temperature is at 112 degrees. A comfortable temperature is maintained in the facility. Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and/or items are inaccessible to clients, (3) fire extinguishers are fully charged. First Aid kit complete and with manual. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CLEARVIEW TREATMENT PROGRAM
FACILITY NUMBER: 198320088
VISIT DATE: 11/30/2022
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During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in the garage. LPA observed staff wearing masks. Clients will be transferred to another facility for isolation (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, No - Fit testing completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & computer for clients to use, clients temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days. All clients and staff are vaccinated and boosted.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

Technical Advisory (TA) issued.


1. Fit testing for N95 not completed.

An exit interview conducted with Leilani Le, Administrator and copy of report provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC809 (FAS) - (06/04)
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