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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005391
Report Date: 02/19/2025
Date Signed: 02/19/2025 12:09:24 PM

Document Has Been Signed on 02/19/2025 12:09 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:NSIGHT PSYCHOLOGY & ADDICTIONFACILITY NUMBER:
306005391
ADMINISTRATOR/
DIRECTOR:		BEATIFICATO, MARY HELENFACILITY TYPE:
772
ADDRESS:206 W.SIERRA DRIVETELEPHONE:
(949) 629-3722
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 6CENSUS: 5DATE:
02/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:17 AM
MET WITH:DenitaTrowel- Program Director, Carly Amaro- Lead Mental Health WorkerTIME VISIT/
INSPECTION COMPLETED:
12:23 PM
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Licensing Program Analyst (LPA) Nancy Guillen conducted and unannounced visit for the purpose of completing a required annual inspection. LPA arrived at the facility and was greeted and granted entry by Lead Mental Health Worker, Carly Amaro after explaining the nature of the visit. LPA met with Program Director (PD), Denita Trowel and began the tour of the facility.


Five clients currently reside at this location, all were away at their day program and returned to the facility for their meditation session with Guillermo Da Silva-Montemayor, Associate Clinical Director. LPA accompanied by Program Director, began the tour of the inside and outside of the facility, facility is a one story home. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. LPA toured the kitchen and food storage areas. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food stored in garage refrigerator and in emergency storage in hallway closet. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a locked hallway closet. LPA reviewed medication and observed medication was labeled and stored inaccessible to clients in care. LPA measured the hot water temperature which measured 80-130 degrees Fahrenheit; a deficiency was cited on today’s date. All bathrooms observed to have a supply of soap, toilet paper and towels. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored and locked in the garage. The facility has an available clean supply of linens. LPA inspected client’s bedrooms which have sufficient lighting to ensure the safety and comfort of clients. All bedrooms observed to have all required components. Storage space is provided for clients in their bedroom. Smoke detectors and carbon monoxide were tested and found to be operational.

Continued on LIC809C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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Document Has Been Signed on 02/19/2025 12:09 PM - It Cannot Be Edited


Created By: Nancy Guillen On 02/19/2025 at 11:31 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NSIGHT PSYCHOLOGY & ADDICTION
FACILITY NUMBER: 306005391

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
81088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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 Based on observation, the licensee did not comply with the section cited above in two out of two bathrooms which poses an immediate safety risk to persons in care. Water temperature measured at 80-130 degree fahrenheight.
POC Due Date: 02/20/2025
Plan of Correction
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Licensee to fix water temperature by POC date. Licensee to send a log of documented water temperature readings daily and submit to LPA by February 28, 2025.
Type A
Section Cited
CCR
81064(f)
Administrator -Qualifications and Duties
(f) Any person designated as an administrator shall be required to complete at least 20-clock-hours of continuing education per year in areas relating to mental health and the care of the mentally ill, and/or administration.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care. administrator did not complete the required annual training required.
POC Due Date: 02/20/2025
Plan of Correction
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Administrator to submit written plan of when trainings will be started and completed and submit to LPA by POC date. Administrator to complete the required trainings and submit proof to LPA by March 5, 2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Armando J Lucero
LICENSING EVALUATOR NAME:Nancy Guillen
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2025


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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: NSIGHT PSYCHOLOGY & ADDICTION
FACILITY NUMBER: 306005391
VISIT DATE: 02/19/2025
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LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there is several seating areas for client’s enjoyment. LPA observed two fire extinguishers with service date of February 6,2025 mounted on the wall of the dinning room and entry way of the facility. LPA verified last emergency drill was conducted on January 2,2025. LPA began review of records. LPA reviewed three clients’ records. All the required documentation was present and current in client’s files reviewed. LPA reviewed four employee electronic records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate however the administrator did not complete the required training to meet the administrative qualifications; a deficiency was cited on today’s date.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
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