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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006448
Report Date: 09/20/2024
Date Signed: 09/20/2024 09:18:23 AM

Document Has Been Signed on 09/20/2024 09:18 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:
09/20/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Nick Risse
Craig Jewett		TIME VISIT/
INSPECTION COMPLETED:
09:35 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.

At 8:40 a.m. LPA toured the facility and observed the following:

· Water temperatures tested at 107 degrees Fahrenheit..

· Facility has a shaded seating area in the backyard.

· Facility has plates, bowls, and cups.

· Facility has battery powered flashlight readily accessible.

· Facility has an evacuation chair available at the top of the stairs.

· Facility has extra supply of clean linen and bedspreads stored in the hallway storage.

· Emergency disaster plan and phone numbers are posted and available for review.

Component III: was conducted during this inspection, information provided about how to operate the facility within compliance and reporting requirements.

The facility is ready to be licensed. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau (CAB) in Sacramento. An exit interview was conducted, and a copy of this report was left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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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