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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880664
Report Date: 02/13/2024
Date Signed: 02/13/2024 05:52:39 PM

Document Has Been Signed on 02/13/2024 05:52 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
RIVERSIDE AC/SC, 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: 6DATE:
02/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Psychiatric Nurse Practitioner, Elizabath AnyanwuTIME COMPLETED:
06:15 PM
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Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that seven (7) clients live at this facility, there were six (6) clients present at the home, at the time of the inspection. There was six (6) staff members present. The Clinic Director, Marcia Lewis conduct and completed the facility tour. LPA Banrasavong spoke to the Licensee, Chris Spencer on the phone during the annual inspection. The Psychiatric Nurse Practitioner, Elizabeth Anyanwu completed the annual inspection.

Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Seven (7) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification.

Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Six (6) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Chris Spencer does not possess a current Administrator’s certificate or the required the training hours.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PSYCH HEALTH CENTERS
FACILITY NUMBER: 331880664
VISIT DATE: 02/13/2024
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Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. LPA observed sharps in a designated location in the kitchen.

Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 75 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 111.0 degrees F. Laundry is done in the designated laundry room. There is a not a locked cabinet for storing laundry soap and cleaning chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is zero (0) fireplace at this facility. There is a secured and gated pool at the facility. There is one (1) gate that has a self-latching lock on the northwest side of the facility, that leads to the exterior of the facility. LPA observed emergency supplies and three (3) first aid with the required components.

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department’s requirements.

Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed if they were dispensed accurately.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PSYCH HEALTH CENTERS
FACILITY NUMBER: 331880664
VISIT DATE: 02/13/2024
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LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA reviewed the annual fire inspection performed by the Palm Springs Fire Department on August 15,2023. The facility has a hardwired fire alarm system with three main fire pulls. There was one (1) carbon monoxide detector. There was seven (7) fire extinguisher on site, last charged date 08/11/2023.

Pursuant to the Title 22 of The California Code of Regulations Division 6, there are three (3) deficiencies observed and that will be cited. Six (6) out of six (6) staff member were escorted out of the facility due to not having Department of Justice background and fingerprint clearance. The Administrator does not have the required credential to be an Administrator. The cleaning supplies were not located and locked in a secure location. An exit interview was conducted, this LIC 809, LIC 809D, appeal rights was reviewed with, and a copy of this report was provided to the Psychiatric Nurse Practitioner, Elizabeth Anyanwu.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 02/13/2024 05:52 PM - It Cannot Be Edited


Created By: Kathleen Banrasavong On 02/13/2024 at 05:11 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: 02/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
81019(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code section 1522 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in allowing [6] out of [6] persons to work at the facility without a DOJ criminal background clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2024
Plan of Correction
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The Licensee has agreed to removed all six (6) staff members from the facility and not allow the six (6) staff members to work at the facility until they have a criminal background clearance. POC is due 02/13/2024. LPA Banrasavong has verified that the six (6) staff members have left the facility on 02/13/2024.
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:Jazmond D Harris
LICENSING EVALUATOR NAME:Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 02/13/2024 05:52 PM - It Cannot Be Edited


Created By: Kathleen Banrasavong On 02/13/2024 at 05:11 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: 02/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
81087(l)
Buildings and Grounds
(l) The licensee shall ensure that items which could pose a danger if readily available to clients, including but not limited to disinfectants, cleaning solutions and poisons are stored where inaccessible to clients.

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 [5 ]out of [5] out of cleaning solutions and cleaning supplies in the open, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/22/2024
Plan of Correction
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The Psychiatric Nurse Practitioner, Elizabath Anyanwu stated that they will lock up the cleaning supplies in a locked drawer. This POC is due on 02/22/2024.
Type B
Section Cited
CCR
81064(a)
Administrator -Qualifications and Duties
(a) All social rehabilitation facilities shall have an administrator.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in having an acting Administrator that doesn't have the appropriate certification, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/22/2024
Plan of Correction
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The Licensee stated that he will have his Administrator training and application due to the LPA by 02/22/2024.
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:Jazmond D Harris
LICENSING EVALUATOR NAME:Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024


LIC809 (FAS) - (06/04)
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