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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011405838
Report Date: 10/16/2024
Date Signed: 10/16/2024 11:27:42 AM

Document Has Been Signed on 10/16/2024 11:27 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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: 12DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Tsion Haile Mogesse, Administator.TIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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On 10/16/2024, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen conducted an unannounced case management visit regarding an incident report that was reported to CCLD on 10/08/2024. LPAs met with Administrator, Tsion Haile Mogesse, and explained the purpose of the visit.

The incident report occurred on 10/05/2024 regarding missed medication for C1 while he was out of the facility with family. LPAs discussed with Administrator about C1's missed medication. Administrator explained that C1 was responsible for C1's medication during the time the incident occurred. Prior to C1's outing, the Administrator reminded C1 and family member about taking medications. After the incident occurred, Administrator contacted the family to remind of how important it is to take medication during outing.


No deficiency cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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