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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880664
Report Date: 03/15/2024
Date Signed: 03/15/2024 10:14:21 AM

Document Has Been Signed on 03/15/2024 10:14 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
RIVERSIDE ASC, 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: 13DATE:
03/15/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Therapist, Christopher MerrittTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to the facility to conduct a case management visit on the health, safety, and welfare of residents in care. LPA met with Therapist, Christopher Merritt. LPA was informed that thirteen (13) residents currently reside at this facility. Thirteen (13) residents were at the facility at the time of the inspection. There were five (5) staff members on duty, during the time of the visit.

LPA toured the facility and observed all facility utilities to be on and operating without issue, food supply is sufficient, there is no immediate concern for residents in care. LPA obtained the resident and staff roster and ensured all staff was background cleared.

Based on the information obtained during today’s visit, there are no deficiencies or civil penalties being cited per California Health & Safety Code and Code of Regulations, Title 22, Division 6. An exit interview was conducted with Therapist, Christopher Merritt and a copy of this report is left with the Facility representative, as evidence by his signature.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
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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