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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005391
Report Date: 03/23/2022
Date Signed: 03/23/2022 03:56:29 PM

Document Has Been Signed on 03/23/2022 03:56 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:NSIGHT PSYCHOLOGY & ADDICTIONFACILITY NUMBER:
306005391
ADMINISTRATOR:BEATIFICATO, MARY HELENFACILITY TYPE:
772
ADDRESS:206 W.SIERRA DRIVETELEPHONE:
(949) 629-3722
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 6CENSUS: 6DATE:
03/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 AM
MET WITH:Denita TrowellTIME COMPLETED:
03:00 PM
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Licensing Program Analyst's (LPA's) Lydia Martinez and Jessica Cho made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control due to the COVID-19 pandemic. LPA Martinez and LPA Cho met with Program Director Denita Trowell and reason for the visit was explained. Program Director Denita Trowell confirmed there are currently no cases or exposures of COVID-19 within the facility. LPA's were screened upon entry into the facility.

LPA's observed the required Department posting on COVID-19 precautions at entrance of facility. There is a sign-in procedure in place and hand sanitizer for use. LPA's observed that staff were wearing face masks. LPA observed 6 clients at the facility, 1 relaxing in their room, 2 were napping, 1 was with their therapist and the other 2 were outside socializing. The facility has an approved Mitigation Plan on file with CCLD. LPA's conducted a tour of the facility and made observations pertaining to the facility's Infection Control measures. LPA's toured all client rooms, all rooms were within regulations. All restrooms observed contained hand washing soap, toilet paper and paper towels and had the proper hand washing signs posted. Facility has operating smoke and carbon monoxide detectors. Fire Extinguisher was charged. The facility was equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Personal Protective Equipment (PPE) supply is available. The facility monitors the clients regularly for any COVID-19 symptoms/change of condition and documents. Facility has required Emergency Disaster Plan posted, and a secured location for client's medication and files. Facility has 30 days supply of medications for the clients.

Based on observations made during today’s inspection, no deficiencies are being cited per Title 22, Division 6, of the California Code of Regulations. LPA's reviewed this report with Program Director and a copy will be emailed.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2022
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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