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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005947
Report Date: 06/23/2022
Date Signed: 06/23/2022 05:29:00 PM

Document Has Been Signed on 06/23/2022 05:29 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 EXODUS CRISIS RESIDENTIAL PROGRAM BE ET ALFACILITY NUMBER:
306005947
ADMINISTRATOR:RACHEL REAGANFACILITY TYPE:
772
ADDRESS:265 S. ANITA DRIVE, SUITE 201TELEPHONE:
(310) 945-3350
CITY:ORANGESTATE: CAZIP CODE:
92866
CAPACITY: 15CENSUS: DATE:
06/23/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Rachel Reagan - Program DirectorTIME COMPLETED:
04:00 PM
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At this Informal Conference meeting held via Teams, the following were in attendance: Marina Stanic, Regional Manager, Sheila Santos, Licensing Program Manager, Patricia Velazquez, Licensing Program Analyst, Adult & Older Adult Behavioral Health, Crisis Recovery Services: Vanessa Thomas, Division Manager, Erika Punchard, Service Chief II, Diego Hernandez, Behavioral Health Clinician II, Amy Couch, Behavioral Health Clinician II, CEO Luana Murphy, Connie Dinh, Senior Vice President of Nursing Services and Rachel Reagan, Program Director.

At this informal Conference the following items were discussed:
  • Discharge Process
  • Issues hindering successful discharge
  • Multidisciplinary Team approach to discharge
  • Reporting Requirements
  • Discharge Extension request and approval criteria


The following was agreed to:
  • Extension of the client’ stay at the facility will be requested for any client at risk of destabilization or decompensation due to retraumatizing event, premature or unsafe discharge.
  • All documents related to discharge and extension requests will be kept on record and available to CCL for review.


A copy of this report will be emailed to Program Director Rachel Reagan who agrees to sign the report and mail the original back to the Orange Regional Office.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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