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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880664
Report Date: 04/29/2022
Date Signed: 04/29/2022 04:33:31 PM

Document Has Been Signed on 04/29/2022 04:33 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PSYCH HEALTH CENTERSFACILITY NUMBER:
331880664
ADMINISTRATOR:SEAN CURTINFACILITY TYPE:
772
ADDRESS:1404 N PALM CANYON DRTELEPHONE:
(800) 334-0394
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY: 16CENSUS: 0DATE:
04/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Property Manager-Adrian AyalaTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Janira Arreola made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Property Manager Adrian Ayala, who was informed of the purpose of the visit. LPA spoke with Administrator Sean Curtin over the phone to coordinate to meet with the Property Manager on site. At the time of visit there was 1 staff and 0 residents present. The facility currently has zero positive or suspected Covid-19 cases.

During today's visit, LPA toured the facility and made observations regarding the infection control measures and to verify that there were no residents present. LPA checked FAS for facility mitigation plan and advised Administrator over the phone, to submit by Monday 4/2/2022.

All areas are open for review and there is no evidence of residents at the facility. LPA advised Administrator to get updated keys for upstairs storage rooms.

LPA and Property Manager observed the following deficiencies:
ยท Expired medication was seen in 2 file drawers in the nurse's station. This will be documented on an LIC 809-D

An exit interview was conducted, and a copy of this report, and appeal rights were reviewed and provided to property manager Adrian Ayala and e-mailed to Administrator Sean Curtin.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
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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Document Has Been Signed on 04/29/2022 04:33 PM - It Cannot Be Edited


Created By: Janira Arreola On 04/29/2022 at 04:15 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PSYCH HEALTH CENTERS
FACILITY NUMBER: 331880664

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80075(l)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 2 drawers in nurses station that had expired medication from previous clients. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2022
Plan of Correction
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Licensee will submit to LPA by POC date showing proper destruction of medications observed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Joel Esquivel
LICENSING EVALUATOR NAME:Janira Arreola
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022


LIC809 (FAS) - (06/04)
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