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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198320356
Report Date:
09/27/2024
Date Signed:
09/27/2024 01:21:26 PM
Document Has Been Signed on
09/27/2024 01:21 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 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:
6
DATE:
09/27/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:00 PM
MET WITH:
DIRECTOR LEILANI LE
TIME COMPLETED:
01:30 PM
NARRATIVE
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On 09/27/2024 around 12 noon Licensing Program Analyst (LPA) Jose Calderon initiated an announced Case Management - Other to Clearview Treatment Programs Technical Assistance to the above said facility.
LPA Calderon was given a tour of the facility's main building by Director Leilani Le. The case management visit was due an incident report dated 08/29/2024 regarding C1. Appears C1 attempted suicide. LPA Calderon requested copies of physician report and hospital records. Records indicate that C1 has a history of health issues. LPA Calderon conducted an interview with Director Leilani Le. Director indicates that the client was located inside a cabinet. Staff indicates that the client had a watch that located C1 inside the facility. Staff indicates that they were looking for C1. Staff located the C1 inside cabinet and C1 was trying to commit suicide. Staff indicates that the client was breathing when staff located C1. Staff indicates that the client was taken to the hospital and did not return. Staff indicates that the client moved to another facility due to C1 family need for another facility that could meet the needs of C1. Staff indicates that the facility discharged C1.
An exit interview was conducted with Director Leilani Le and a hard copy was provided by hand for signature.
SUPERVISOR'S NAME:
Ulysses Coronel
TELEPHONE:
(323) 400-7397
LICENSING EVALUATOR NAME:
Jose Calderon
TELEPHONE:
(323) 213-1153
LICENSING EVALUATOR SIGNATURE:
DATE:
09/27/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/27/2024
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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