306006638-3-12-2025-22-AS-NGUN-DEPPER-20250312111535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006638
Report Date: 03/12/2025
Date Signed: 03/12/2025 11:20:39 AM

Document Has Been Signed on 03/12/2025 11:20 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	PACE RECOVERY CENTER, LLC		FACILITY NUMBER:	306006638
ADMINISTRATOR/ DIRECTOR:	SUZMEYAN, SHAHAN		FACILITY TYPE:	735
ADDRESS:	221 11TH ST		TELEPHONE:	(800) 526-1851
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92648
CAPACITY: 6		CENSUS: 0	DATE:	03/12/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Shahan Suzmeyan		TIME VISIT/ INSPECTION COMPLETED:	11:45 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) Nancy Guillen conducted an announced visit to the facility for purpose of a pre-licensing evaluation.

An initial application to operate an Adult Residential Facility for six ambulatory clients was submitted to CCL on February 7, 2025.

LPA met with applicant Shahan Suzmeyan. LPA observed that Administrator Shahan Suzmeyan has a valid Administrator certificate which expires on January 16,2027. Applicant is background cleared and associated to the facility. Applicant was joined by Shawn Kelly and Leon Jett to assist with the pre-licensing inspection. The facility received an approved Fire Clearance by Huntington Beach Fire Authority Inspector Ruben Solorzano on October 17, 2024.

The facility is a two-story home with four client bedrooms, four client bathrooms, a kitchen, dining room, living room, family room, laundry room, covered patio, front porch and garage. LPA accompanied by the applicant, conducted a tour of the physical plant. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the living room. LPA inspected the four client bedrooms. The four client bedrooms are clean and free of hazards. LPA observed all the client bedrooms has the required furnishings of a bed, a chair, chest of drawers, and a lamp. Client beds have clean linens and blankets. LPA observed additional linens stored in the second floor family room closet. Client bathrooms are clean. Bathrooms were equipped with grab bars and non-slip mats. Faucets and toilets were operational. Hot water temperature measured between 109.4-114 degrees Fahrenheit. LPA observed the facility has an emergency food supply stored in hallway closet.

LIC 809C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PACE RECOVERY CENTER, LLC	FACILITY NUMBER: 306006638
	VISIT DATE: 03/12/2025

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
26
27
28
29
30
31
32

LPA observed the facility has board games and books for client's use stored in the first floor living room. The facility has an internet device for client use next to the living room. Client and staff records will be kept locked in a filing cabinet in a common room next to the living room.

LPA observed the electric stove, the refrigerator, the microwave, and the dishwasher to be clean and operational. LPA observed knives to be locked inside a locked cabinet in the common room next to the living area. There are three fire extinguishers which are located by the common area and at the top of the two staircases. Fire extinguishers were observed to be charged and serviced as of September 17,2024. LPA tested the wired smoke/carbon monoxide detectors which tested operational. The centrally stored medication will be located in the common area in a locked cabinet. LPA observed the First Aid Kit had all the required components. The garage is inaccessible to clients and is used for storage including toxins and cleaning supplies.

LPA accompanied by the applicant toured the outside of the facility and observed it to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for client use. The perimeter gate on the exterior of the facility is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises.

Component III was completed with the applicant which provided information about how to operate the facility within compliance and reporting requirements. The applicant was notified that the final application approval will be issued by the Centralized Applications Bureau (CAB) in Sacramento for final review prior to license being issued. An exit interview was conducted, and a copy of this report was left with the applicant.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC809 (FAS) - (06/04)

Page: 2 of 2