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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011405838
Report Date: 04/30/2024
Date Signed: 04/30/2024 06:45:55 PM

Document Has Been Signed on 04/30/2024 06:45 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ABLELIGHT, INC - MOWRYFACILITY NUMBER:
011405838
ADMINISTRATOR/
DIRECTOR:		CHRISTINA O QUINTANAR-SANCFACILITY TYPE:
735
ADDRESS:1335 MOWRY AVETELEPHONE:
(510) 505-1245
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 12CENSUS: 11DATE:
04/30/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Troy Rice, Interim Administrator
Fidel De Castro, Lead DSP 2		TIME VISIT/
INSPECTION COMPLETED:
06:50 PM
NARRATIVE
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On 4/30/2024 at 2:50PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct Case Management - Annual Continuation. LPA met with Interim Administrator, Troy Rice and Lead DSP 2, Fidel De Castro. LPA explained the purpose of the visit.

During visit, LPA reviewed client's P&I money with log. LPA interviewed 3 clients and 3 staff starting at 4:00PM. LPA reviewed a sample of client's medications at around 5:15PM. LPA observed facility has a surety bond and last disaster drill was conducted on 2/25/2024.


At around 3:30PM, LPA observed C3 and C4's P&I money and log does not match. LPA observed the P&I log was not completed accurately.

The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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Document Has Been Signed on 04/30/2024 06:45 PM - It Cannot Be Edited


Created By: Grace Luk On 04/30/2024 at 06:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ABLELIGHT, INC - MOWRY
FACILITY NUMBER: 011405838

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80026(h)
(h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above by not having P & I log maintained accurately which poses a potential personal rights risk to persons in care.
POC Due Date: 05/17/2024
Plan of Correction
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Administrator has agreed to conduct training for P & I log and review all client's P & I logs. Administrator will submit C3 and C4's P & I log and staff training information to CCLD by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Harpreet Humpal
LICENSING EVALUATOR NAME:Grace Luk
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024


LIC809 (FAS) - (06/04)
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