<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006362
Report Date: 10/31/2024
Date Signed: 10/31/2024 12:31:15 PM

Document Has Been Signed on 10/31/2024 12:31 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:ALTER MENTAL HEALTH - DANA POINT, LLCFACILITY NUMBER:
306006362
ADMINISTRATOR/
DIRECTOR:		BUSS, WHITNEYFACILITY TYPE:
772
ADDRESS:33522 AVENIDA CALITATELEPHONE:
(949) 538-7457
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 6CENSUS: 6DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:17 AM
MET WITH:Whitney BussTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Joseph Alejandre and Brandon Lopez made an unannounced visit. LPAs were greeted and granted entry by staff. LPAs met with Administrator Whitney Buss and explained the reason for the visit. LPAs and Administrator toured the facility. The facility is a two-story house with four client bedrooms upstairs, three bathrooms, living room, kitchen, dining room, laundry room, staff office (with plexiglass walls, therapy room and attached four-car garage. LPAs observed the See Something, Say Something poster (PUB 475) prominently posted by the main entry door. LPAs and Administrator toured the kitchen. LPAs observed two day perishable and seven day non perishable supply in the kitchen. LPAs observed the four burner gas stove top lights unassisted. LPAs observed all medications and sharp objects are kept locked in the staff office. LPAs and Administrator inspected the bathrooms. All bathrooms are clean and operational. The hot water measured 127.9 to 129.0 degrees Fahrenheit. LPAs observed there is four client rooms. LPAs observed all four client rooms has the required furnishings. LPAs observed there is no emergency evacuation chair for the stairway. Cleaning supplies are kept locked in the laundry room. The garage has exercise equipment for client use. LPAs observed a three day supply of emergency food and water in the garage. LPAs and Administrator toured the backyard. There is a pool surrounded by a fence in the backyard. The pool is inaccessible to clients. The exit gate on the south side of the house has an alarm that is operational. The gate is latched and self closing. There is a plastic shed in the backyard which is used for storage and kept locked. LPAs observed a covered patio in the backyard with table and chairs for clients to sit outside. No obstacles or hazards were observed in the backyard. LPAs observed all 8 fire extinguishers are fully charged. The last emergency drill was conducted April 5, 2024. Smoke detectors/carbon monoxide detectors tested operational. LPAs reviewed three staff files. All three staff members had the required training, including first aid training. All staff present at the facility are background cleared and associated to the facility. LPA reviewed 6 client files and medications, no discrepancies observed. Deficiencies are being cited per Title 22 Chapter 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report along with appeal rights were provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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 4
Document Has Been Signed on 10/31/2024 12:31 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 10/31/2024 at 12:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ALTER MENTAL HEALTH - DANA POINT, LLC
FACILITY NUMBER: 306006362

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1565(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above, Facility records show the last emergency drill was conducted on April 5, 2024 which poses an immediate health and safety risk to persons in care.
POC Due Date: 11/01/2024
Plan of Correction
1
2
3
4
Licensee agrees to conduct an emergency drill by the POC due date. Licensee agrees to comply with the regulation above. Licensee to forward documentation of the drill to the LPA.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/31/2024 12:31 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 10/31/2024 at 12:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ALTER MENTAL HEALTH - DANA POINT, LLC
FACILITY NUMBER: 306006362

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
81088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above, The hot water measured 127.9 to 129.0 degrees Fahrenheit which poses a potential health and safety risk to persons in care.
POC Due Date: 11/07/2024
Plan of Correction
1
2
3
4
Licensee agrees to adjust the water temperature to 105.0 - 120.0 degrees Fahrenheit and to maintain the required water temperature at all times.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4