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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006448
Report Date: 09/13/2024
Date Signed: 09/13/2024 10:05:10 AM

Document Has Been Signed on 09/13/2024 10:05 AM - 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:CASTLEGATE LLCFACILITY NUMBER:
306006448
ADMINISTRATOR/
DIRECTOR:		RISSE, NICKFACILITY TYPE:
772
ADDRESS:9452 CASTLEGATE DR.TELEPHONE:
(714) 330-2442
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 6CENSUS: 0DATE:
09/13/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Nick RisseTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with designated Administrator (AD) Nick Risse and Compliance Officer Craig Jewett. An application to operate a Social Rehabilitation Facility for (6) capacity, (6) ambulatory, (0) non-ambulatory, and (0) bedridden clients was received by CCL on November 1, 2023.

Structure:
The facility is a two-story house with five client bedrooms, two staff offices, four bathrooms, a living room, a kitchen, a dining room, and attached two car garage. There is a backyard with a fenced pool, a covered above ground hot tub, and an exit gate each side of the house. LPA did not observe any obstacles in the backyard.

Resident Bedrooms
All client bedrooms had the required furnishings. LPA observed all beds had linens and blankets.

Signal system
There is no signal system.

Toxins:
All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients and will be stored and locked in the laundry room.

Medications, First-Aid Kit & Book:
Medication will be stored in a locked closet within the locked staff office. First aid kit is stored in the staff office and mounted on the wall in the dining room. The first aid kit has all the required elements.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CASTLEGATE LLC
FACILITY NUMBER: 306006448
VISIT DATE: 09/13/2024
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Resident & Staff Files:
Records will be kept in the staff office.

Pool/Jacuzzi:
Pool was observed to be fenced, with a mesh fence measuring five feet in height. Mesh fence does not obscure the pool from view. The gate was observed to swing away from the pool, is self-closing and has a self-latching device located within six inches from the top of the gate. Above ground hot tub was observed to be covered and cover is locked.

Fire Extinguisher:
Fire extinguisher is fully charged with service tag dated September 9, 2024.

Fire clearance:
Was approved by a fire inspector of Huntington Beach Fire Department on January 18, 2024. No special conditions noted.

Bedrooms Staff:
There is one staff bedroom.

Bathrooms:
All bathrooms have working plumbing.

Food Service:
A supply of 2-day perishable and 7-day of non-perishable food will be maintained on hand.

Smoke Detectors:
Smoke detectors and carbon monoxide detectors tested operational.

Appliances:
Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CASTLEGATE LLC
FACILITY NUMBER: 306006448
VISIT DATE: 09/13/2024
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Licensee to address the following corrections by October 1, 2024:

· Hot water measured between 130.6.8- and 138.3-degrees Fahrenheit.

· Emergency disaster plan and phone numbers were not posted or available for review.

· There are no plates, bowls, or cups.

· There is no shaded seating area.

· Emergency lighting is not available.

· Evacuation chair is not available.

LPA will make an additional announced visit to follow-up on corrections listed above. An exit interview was conducted, and a copy of this report was provided to designated AD.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC809 (FAS) - (06/04)
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