198320356-5-5-2023-11-AS-WGIS-CRJRXS-20230505132513

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320356
Report Date: 05/05/2023
Date Signed: 05/05/2023 01:25:19 PM

Document Has Been Signed on 05/05/2023 01:25 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	CLEARVIEW TREATMENT PROGRAMS		FACILITY NUMBER:	198320356
ADMINISTRATOR:	LE, LEILANI		FACILITY TYPE:	735
ADDRESS:	1171 NELROSE AVENUE		TELEPHONE:	(310) 862-8980
CITY:	VENICE	STATE: CA	ZIP CODE:	90291
CAPACITY: 6		CENSUS: 0	DATE:	05/05/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:21 AM
MET WITH:	Leilani Le		TIME COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 05/05/23 at 10:30am, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an announced Pre-Licensing visit at Clearview Treatment Program. LPA Gibbs met with Administrator, Leilani Le, Compliance Coordinator, Emily Osborne, and CEO, Roman Olay. The facility will be operating as an Adult Residential Facility. The Fire Safety Inspection was approved on 03/17/23, for six (6) ambulatory adults ages 18 through 59. Structure The facility is a two-story home in a residential neighborhood. The facility consists of four (4) bedrooms, two (2) bathrooms, Kitchen, dining room, living room, sitting room, staff office, detached garage, and outdoor area. On the first floor are two (2) bedrooms, bathroom, kitchen, dining room, and sitting room. On the second floor are two (2) bedrooms, bathroom, living room, and staff office. Physical Plant LPA toured the facility inside and outside. The front and backyard are well maintained. In the back is a seating area with table and umbrella. LPA did not observe any bodies of water on the premises. LPA observed all walkways to be clean, clear, and free of obstructions, hazards, and debris. All gate on the side of the house are easily opened and accessible. The detached garage is currently being used as storage. Bedroom LPA toured all four (4) bedrooms. Two (2) of the client bedrooms are on the first floor, one (1) room is a private room and the second is a double for two (2) clients. The additional two (2) bedrooms are on the second floor, one room is a single and the second bedroom is a double. All rooms had the required furniture including bed(s), dresser(s), nightstand(s) with a lamp, chair(s), and ample storage space for client’s personal belongings. All the beds had the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. An additional ample supply of linens are stored in the closet under the stairs. Bathrooms LPA inspected both bathrooms. LPA found both bathrooms to be in good working repair. The shower, bathtub, faucets, and toilets are fully functioning. All showers were clean and sanitary. LPA observed a nonskid shower mat in both showers and bathtub. All bathrooms have ample supply oh hand soap and paper towels. An ample supply of hygiene and feminine products were stored in the bathroom and an additional supply in the staff office. LPA observed an ample supply of towels in a cabinet in the bathrooms. The water temperature measured 113.7-degrees and 112.3-degrees Fahrenheit.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

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: CLEARVIEW TREATMENT PROGRAMS	FACILITY NUMBER: 198320356
	VISIT DATE: 05/05/2023

NARRATIVE

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Kitchen LPA observed all appliances including dishwasher, microwave, stove/oven, and refrigerator to be in good working repair. LPA observed an ample supply of cutleries, pots, and pans to be in good repair. LPA observed a 7-day supply of nonperishable foods. Sharps and cleaning supplies are secured in a locked cabinet in the staff office. The water temperature measured at 115.7- degrees Fahrenheit.

Common Rooms LPA toured the sitting room, dining room and living room. The sitting room has two couches, chair, and tables. There are books and magazines for client use. There is a gas fireplace that is not connected. There is enough seating to accommodate all clients. In the dining room LPA observed a long rectangular table, and chairs to accommodate all clients. In the living room LPA observed a large L-shaped couch to accommodate all clients, a television, and entertainment center with games for client use. LPA observed all rooms to have ample lighting. All walkway and hallways were clean, clear, and free of obstructions and hazards. The railing on the staircase is secured. The facility was maintained at a comfortable temperature.

Safety LPA observed all rooms and hallways to have smoke/carbon monoxide detectors. LPA observed two (2) fully charged fire extinguisher, one mounted in the dining room and the other upstairs in the living room, and serviced on 08/25/22. LPA observed a facility sketch in the dining room and at the top of the stairs that indicate all exits and shut off valves. All shut off valve are clearly marked. LPA observed the First Aid Kit to contain the required items and a manual. LPA observed all mandated signs and documents posted and visible. The facility has a working landline and internet for client use.

Medication and Files LPA was informed client medications and files will be kept in the staff office in a locked cabinet and filing drawer. The staff office will be locked when staff are not in the office.

Component III LPA reviewed Component III with Administrator, Leilani Le and Compliance Coordinator, Emily Osborne.

LPA did not observe any corrections that need to be made.

LPA conducted an exit interview with Compliance Coordinator, Emily Osborne and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

LIC809 (FAS) - (06/04)

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