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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604013
Report Date: 01/30/2025
Date Signed: 01/30/2025 06:40:33 PM

Document Has Been Signed on 01/30/2025 06:40 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:CROWNVIEW PSYCHIATRIC INSTITUTE INC.FACILITY NUMBER:
374604013
ADMINISTRATOR/
DIRECTOR:		MELIESSA MARTINEZFACILITY TYPE:
772
ADDRESS:1110 CAMINO DEL SOL CIRCLETELEPHONE:
(760) 231-1170
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: 6CENSUS: 2DATE:
01/30/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:01 PM
MET WITH:Program Administrator, Melissa MartinezTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Incident visit. LPA discussed the purpose of the visit with Program Administrator, Melissa Martinez.

On 01/28/25, the facility's Program Administrator self reported an incident involving Client #1 (C1). C1's Physician's Repot dated 10/29/24 indicted C1 can leave the facility unassisted. C1 ran out of the house and staff began search. Staff were unable to locate C1 and contacted C1's responsible party and local law enforcement. Law enforcement located C1 and transported C1 to the hospital for evaluation.

Today, the facility was briefly toured, records requested and interviews conducted with staff. No deficiencies were issued today. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Program Administrator, Melissa Martinez whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Client #1].
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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