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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604013
Report Date: 08/19/2022
Date Signed: 08/19/2022 01:04:14 PM

Document Has Been Signed on 08/19/2022 01:04 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:CROWNVIEW PSYCHIATRIC INSTITUTE INC.FACILITY NUMBER:
374604013
ADMINISTRATOR:BRITTANY PERKINSFACILITY TYPE:
772
ADDRESS:1110 CAMINO DEL SOL CIRCLETELEPHONE:
(760) 231-1170
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: 6CENSUS: 0DATE:
08/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Jennifer Vargas, Administrator TIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Daniela Huerta visited the facility to conduct an annual required licensing inspection. LPA disclosed the purpose of the visit, was granted entry into the facility, and met with Jennifer Vargas, Administrator.

During today’s visit, LPA toured the facility and verified compliance with infection control practices. LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for visitors; a sign-in policy enacted for visitors; signs in the facility to promote hand hygiene, cough/sneeze etiquette, symptom and transmission awareness; face coverings worn by staff; hand sanitizer/hand washing stations readily available; and an ample supply of cleaning products.

No deficiencies were cited during today’s visit. An exit interview was conducted with Jennifer Vargas, and a copy of this report and Licensee Rights (LIC 9058 FAS 01/16) was provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniela Huerta
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2022
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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