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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880664
Report Date: 02/07/2023
Date Signed: 02/27/2023 11:55:13 AM

Document Has Been Signed on 02/27/2023 11:55 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, 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:
02/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:BOARD MEMBER, KEVIN DOUD.TIME COMPLETED:
12:20 PM
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On February 27, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the above facility for an unannounced required annual with emphasis on infection control.

LPA Mixson was greeted and granted entry by Board Member introduced self and stated the purpose of the visit.

Present in the facility were zero residents and zero staff.

LPA Mixson toured the facility and made observations pertaining to the facility's infection control measures.

LPA Mixson observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and the proper use of face coverings.

Information obtained from the Board Member stated that the facility has been closed and not operational for about two years with plans to reopen as soon as possible.

LPA Mixson later discussed infection control practices and procedures with Board Member.

An exit interview was conducted and a copy of this report was given to Board Member.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
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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