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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005396
Report Date: 09/28/2021
Date Signed: 09/28/2021 12:01:56 PM

Document Has Been Signed on 09/28/2021 12:01 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:PACE RECOVERY CENTER LLCFACILITY NUMBER:
306005396
ADMINISTRATOR:WILLIAM SANCHEZFACILITY TYPE:
772
ADDRESS:211 22ND STTELEPHONE:
(213) 924-6442
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY: 6CENSUS: 5DATE:
09/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:C.O.O Sean Kelly and Case Manager Matt BocksTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, granted entry into the facility by Staff and explained the reason for the visit.

During the visit LPA toured the facility with Chief Operations Officer Sean Kelly and Case Manager Matt Bocks. Facility is a 3 bedroom and 4 bathrooms three story home. There are 5 Clients in care. LPA observed Department postings. LPA toured all Clients rooms, all rooms where within regulations. All restrooms observed contained working water basin, soap, toilet paper, and paper towels. Clients were observed relaxing in the Living rooms watching TV. Facility has 3 fire extinguishers which are fully charged. Facility has supply of PPE. Facility has refrigerator and pantry with ample food supply. LPA observed facility has emergency food and water supply. Facility has Evacuation Plan and Personal Rights posted. Facility has a secured location for client medication and files. Facility has 30 days supply of medications for clients. LPA reviewed clients files during visit. Clients emergency contact information and Physicians reports are current.

No deficiencies noted during todays visit. An exit interview was conducted with Chief Operations Officer and a copy of report was left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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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