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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005396
Report Date: 09/11/2024
Date Signed: 09/11/2024 12:11:29 PM

Document Has Been Signed on 09/11/2024 12:11 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:PACE RECOVERY CENTER LLCFACILITY NUMBER:
306005396
ADMINISTRATOR/
DIRECTOR:		WILLIAM SANCHEZFACILITY TYPE:
772
ADDRESS:211 22ND STTELEPHONE:
(213) 924-6442
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY: 6CENSUS: 6DATE:
09/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:00 AM
MET WITH:Chief Strategy Officer Shahan SuzemeyanTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On 9/11/2024, Licensing Program Analyst's (LPA's) Jenifer Tirre and William Venagas conducted an unannounced required visit using the CARE Inspection Tool. LPA's were greeted by staff and granted entry after stating the purpose of the visit. Chief Strategy Officer Shahan Suzemeyan and Director of Operations Bryan Johnson was present to assist with the facility inspection on today's date.

The facility is licensed for six (6) ambulatory clients. Facility is a Short Term Crisis Residential Treatment Program for a Social Rehab.

This is a three story with a two-car garage facility. The facility has three shared Client bedrooms, one staff office, three full bathrooms and one half bathrooms.

Upon arrival LPA's conducted Client interviews due to clients heading out to group activity, At 8:30 LPA's conducted a tour of the physical plant accompanied by Director of Operations, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bathrooms were operational with water temperature measured between 108.2 to 117.1 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility.



LPA's observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, toxins and sharps objects were stored and not accessible to clients. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility fire extinguishers were fully charged and mounted. Facility has three extinguishers. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance.

CONTINUED ON 809C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: PACE RECOVERY CENTER LLC
FACILITY NUMBER: 306005396
VISIT DATE: 09/11/2024
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During the visit, LPA's observed the facility's infection control practices. LPA's observed screening protocols for visitors, staff, and clients. LPA's observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 4/17/24. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 9/16/23-9/16/24.

A review of three clients (C1-C3) service files and three staff (S1-S3) personnel files revealed to be complete.

No deficiencies during this inspection visit.

An exit interview was conducted with Chief Strategy Officer Shahan Suzemeyan, and a copy of the report was provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC809 (FAS) - (06/04)
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