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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005412
Report Date: 05/24/2022
Date Signed: 05/24/2022 03:48:22 PM

Document Has Been Signed on 05/24/2022 03:48 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:AMHS TELECARE TREEHOUSE CRISIS RESIDENTIAL NORTHFACILITY NUMBER:
306005412
ADMINISTRATOR:BRYAN SAWLSVILLEFACILITY TYPE:
772
ADDRESS:2026 W.BEACON AVENUETELEPHONE:
(657) 276-7030
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 6DATE:
05/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Cindy TamayoTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lydia made an unannounced visit to the facility to conduct a Required 1 Year evaluation. Upon arrival, LPA met with Interim Clinical Director Cindy Tamayo and reason for visit was explained. The focus of the visit is Infection Control. LPA toured the facility with Ms. Tamayo and the following was observed: COVID signs were posted at the front entrance of facility and throughout. LPA observed a sanitization station at entrance. LPA was screened and a sign in sheet was available. Facility has required Department postings. Restrooms observed contained soap, paper towels and toilet paper. Hand sanitizer, soap, wipes and gloves were present and in sufficient supply. The facility has at least a 30 day supply of PPE. LPA observed an outside visitation area with ample shading. The swimming pool meets Title 22 regulation at this time. Five Clients were present and were observed resting in their room and others watching TV. Social distancing and masks for staff were observed. Facility has required Mitigation plan and Emergency Disaster Plan. Facility has emergency food and water supply. LPA observed the Medication room. All Clients have at least a 30 day supply of medications. During the visit, LPA consulted with staff regarding the importance of maintaining a 30 day supply of PPE on site. Additionally, LPA advised the importance of mask wearing and hand washing for staff. Staff is reminded to review PINS in regards to Visitation, Dining, Group Activities, Non-essential services, Outings, New Admissions and Entertainment, as well as Staff Testing and Masking Guidelines. All staff have had vaccines and the booster shot. All clients are vaccinated and or tested upon admission.
No deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was provided via email during the visit.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2022
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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