374604704-8-29-2023-08-AS-DNGN-CV6QQK-20230829122228

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604704
Report Date: 08/29/2023
Date Signed: 08/29/2023 12:22:46 PM

Document Has Been Signed on 08/29/2023 12:22 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:	374604704
ADMINISTRATOR:	GLADSTONE, KENNETH		FACILITY TYPE:	772
ADDRESS:	1114 VISTA WAY		TELEPHONE:	(760) 557-9894
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92054
CAPACITY: 6		CENSUS: 0	DATE:	08/29/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Licensee's Representatives, John Paul "JP" Flores and Kenneth Gladstone		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Dang Nguyen conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified himself to, and explained the purpose of the visit to the applicant’s representatives, John Paul "JP" Flores and Kenneth Gladstone. The facility fire clearance was granted on 05/24/2023 and reflects that the facility was approved for six (6) clients in total, of which all must be ambulatory. The facility's fire clearance did not include endorsements for delayed-egress doors or secured perimeter, and neither were present during today's visit. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPA, accompanied by the applicant’s representatives, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Client bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was complaint at 69 degrees F for the main house, and 70 degrees F for the accessory dwelling unit (ADU). Hot water temperature at taps accessible to clients were also compliant. In the main house: Kitchen sink was 109 F, Bathroom #1 sink was 118.4 F, Bathroom #2 sink was 109.9 F, Bathroom #3 sink was 108.9 F, and Bathroom #4 sink was 107.8 F. In the ADU: Kitchen sink was 110 F, Bathroom #6 sink was 109 F, Bathroom #7 was 115 F, and Bathroom #8 was 115.5 F. [CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: 374604704
	VISIT DATE: 08/29/2023

NARRATIVE

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[CONTINUED FROM LIC 809]

The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future client use. All kitchen appliances were in working order and compliant. In the main house: Kitchen refrigerator temperature was 33 F, Kitchen freezer temperature was -8 F, and Medication refrigerator temperature was 33 F. In the ADU: Kitchen refrigerator temperature was 35 F, and Kitchen freezer temperature was 0 F.

The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and client activities. The facility has locked areas for storage of medication and confidential client and staff records.

No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Per the applicant’s representatives, no firearms or ammunition are or will be stored at the facility.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguishers were serviced within the last 12 months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility.

The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection.

LPA also provided the Component III Training during today’s visit. Flores and Gladstone were advised that the facility’s application is pending management final review and approval.

An exit interview was conducted with the applicant’s representatives, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC809 (FAS) - (06/04)

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