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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320349
Report Date: 03/14/2023
Date Signed: 03/14/2023 03:55:02 PM

Document Has Been Signed on 03/14/2023 03:55 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CLEAR RECOVERY CENTERFACILITY NUMBER:
198320349
ADMINISTRATOR:SHADFAN, BASELFACILITY TYPE:
772
ADDRESS:1208 HIGHVIEW AVETELEPHONE:
(877) 799-1985
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY: 6CENSUS: 0DATE:
03/14/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Basel ShadfanTIME COMPLETED:
04:05 PM
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On March 14, 2023, Licensing Program Analyst (LPA) Felisa Shirley and Licensing Program Manager (LPM) Stephanie Cifuentes met with Administrator/Director Basil Shadfan and conducted an announced visit to the facility for the purpose of a prelicensing evaluation. An application was submitted to CCLD for an Initial license for a Social Rehabilitation Facility. The requested capacity is for six (6) Ambulatory clients from ages 18 to 59 years old.

The facility site is a two-story home in a residential area. A tour of the physical plant and surrounding grounds was conducted and the following observed:

KITCHEN: There were 2 days of perishable and 7 days of nonperishable food. The kitchen was equipped with sufficient dining and cook ware to accommodate a maximum capacity of six (6) clients. Appliances and fixtures appeared to be in good condition and were functional. The hot water delivered at 120.5 F.

BEDROOMS: There were three (3) bedrooms designated for client use, two (2) on the ground floor and 1 on the second floor. All bedrooms were furnished for double occupancy and included all required furnishings, linens and bedding. There were no visible hazards.

BATHROOMS: There are three (3) bathrooms. There are 2 full baths with double sinks and one with one sink. All bathrooms were properly supplied with hygiene items and had functional fixtures.

COMMON AREAS: LPA Shirley observed a living room, dining area, meditation room and activity room. The common areas included furnishing capable of accommodating a maximum capacity of 6 clients. There were no visible hazards.


SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023
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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CLEAR RECOVERY CENTER
FACILITY NUMBER: 198320349
VISIT DATE: 03/14/2023
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LPA observed night lights on stairways and hallways for safety at night. A first aid kit has been inspected and has at least the following: antiseptic, bandages, gauze and current first aid manual, which are stored in a locked cabinet and available for staff use but inaccessible to clients.

LPA Shirley observed locked file cabinet in therapy room, where staff and client files will be stored.

SURROUNDING GROUNDS: The property is fenced and there is a patio area with an umbrella for shade and furniture appropriate for outdoor use. There were no visible immediate hazards.

Component III was completed on 03/14/2023 with Amber Jones and Kirsten Uppercue to discuss information about how to operate the facility within substantial compliance.

An exit interview was conducted, and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC809 (FAS) - (06/04)
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