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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005875
Report Date: 03/11/2022
Date Signed: 03/11/2022 02:35:25 PM

Document Has Been Signed on 03/11/2022 02:35 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:PACIFIC SOLSTICE INTEGRATIVE CLINICFACILITY NUMBER:
306005875
ADMINISTRATOR:DEVEREUX, BRITTENFACILITY TYPE:
775
ADDRESS:26732 CROWN VALLEY PKWY #443TELEPHONE:
(949) 402-9520
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 30CENSUS: 0DATE:
03/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Rams Florento, ManagerTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA arrived at facility, was greeted and granted entry by Manager Rams Florento after explaining the purpose of the visit.

At approximately 2:05am, LPA accompanied by Manager began the tour of the facility. The facility maintains a license for an Adult Day Program but has not actively started receiving clients in that capacity. At this time, the facility only receives patients through their Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) licensed through the Department of Public Health. Patients from these programs are observed taking part in group therapy or in the common areas. Facility appears to be clean, sanitary and free of odors in all areas inspected. Cleaning supplies and other toxic substances are located in a locked room.
LPA observed the facility has COVID-19 Precautions posters, all required department postings and hand washing signs posted throughout. Facility has an adequate supply of PPE and adequate Infection Control procedures in place.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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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