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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011405838
Report Date: 01/02/2025
Date Signed: 01/02/2025 05:45:34 PM

Document Has Been Signed on 01/02/2025 05:45 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
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:
01/02/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Tsion Haile Mogesse, Administrator TIME VISIT/
INSPECTION COMPLETED:
05:45 PM
NARRATIVE
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On 01/02/2025 at 1:00 PM Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Administrator, Tsion Haile Mogesse and explained the purpose of the visit. Administrator certificate is current and expires on 01/15/2026. The Administrator number is 7014383735. The facility’s fire clearance was approved for eleven (11) ambulatory and one (1) may be non-ambulatory in room 7.

LPAs toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 12 total bedrooms which all 12 bedrooms are occupied by the clients. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 73 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 119.3 degree Fahrenheit. All toilets, hand washing and bathing are safe, sanitary and in operating condition. The supply of extra hygiene products was available for clients. There is a minimum of one week supply of nonperishable and 2-day perishables food supply.

Fire extinguisher was last serviced on 08/22/2024. Emergency Disaster Drill was last posted on 12/02/2024. First aid kit was observed to be complete. Emergency Disaster Drill was last conducted on 10/24/2024. Fire drill was last conducted on 12/25/2024.

At 1:54 PM, LPAs reviewed 5 of 12 client records. At 4:36 PM, LPAs reviewed staff records and 4 of 4 and are associated to the facility. At 4:45 LPA reviewed client's medications and P & I records.

Continue to LIC809-C...
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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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Document Has Been Signed on 01/02/2025 05:45 PM - It Cannot Be Edited


Created By: Patricia Manalo On 01/02/2025 at 05:17 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: 01/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in having unlocked cleaning chemicals in the garage cabinet and Lysol spray in the staff bathroom which poses an immediate health and safety risk to persons in care.
POC Due Date: 01/03/2025
Plan of Correction
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Administrator will lock the cleaning chemicals and send proof to CCLD by POC date.
Type A
Section Cited
CCR
80075(k)(1)
Health-Related Services
(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by having unlocked nasal spray in the linen closet which poses an immediate health and safety risk to persons in care.
POC Due Date: 01/03/2025
Plan of Correction
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Staff removed the nasal spray and locked it in the Medication Room. Deficiency cleared during the visit.
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:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Patricia Manalo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/02/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/02/2025 05:45 PM - It Cannot Be Edited


Created By: Patricia Manalo On 01/02/2025 at 05:19 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: 01/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80070(a)
Client Records (a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the Administrator did not comply with the section cited above by not having all the client’s documents in file readily accessible which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/03/2025
Plan of Correction
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Administrator agrees to fix all client's records and have it completed and send 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:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Patricia Manalo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/02/2025


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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ABLELIGHT, INC - MOWRY
FACILITY NUMBER: 011405838
VISIT DATE: 01/02/2025
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Continue from LIC809...

Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 01/10/2025:

LIC 500 Personnel Report
LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 400 Affidavit Regarding Client/Resident Cash Resources
LIC 402 Surety Bond
LIC 610 Emergency Disaster Plan
Auto Insurance
Drivers Licence
Car Registration

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
LIC809 (FAS) - (06/04)
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