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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005361
Report Date: 10/24/2024
Date Signed: 10/24/2024 12:36:38 PM

Document Has Been Signed on 10/24/2024 12:36 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SPRINGWELL HAVEN, LLCFACILITY NUMBER:
306005361
ADMINISTRATOR/
DIRECTOR:		RAMIL DE LOS SANTOSFACILITY TYPE:
740
ADDRESS:2424 FRANCISCO DRIVETELEPHONE:
(949) 524-3484
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY: 6CENSUS: 6DATE:
10/24/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Kristy ValerioTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced plan of correction visit to follow up on citations issued on 10/07/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit.

At 12:05 PM, LPA toured the facility and observed the following:

*Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has been cleared. Medications are secured during today's visit. Licensee has complied with the terms of the POC.

*Deficiency cited under Title 22 Regulation 87608(a)(5)(A) pertaining to Postural Supports has been cleared. Licensee removed rails. Licensee has complied with the POC.

*Deficiency cited under Health and Safety Code 1569.695(c) pertaining to Emergency Drills has been cleared. Licensee conducted drill. Licensee has complied with the POC.

*Deficiency cited under Title 22 Regulation 87628(a) pertaining to Diabetes has been cleared. Licensee provided proof of correction. Licensee complied with the POC.

Licensee addressed items on advisory note issued on 10/07/2024.

Licensee has been advised to maintain all items in compliance.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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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