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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209200
Report Date: 09/07/2022
Date Signed: 09/07/2022 09:57:25 AM

Document Has Been Signed on 09/07/2022 09:57 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ABLELIGHT, INC. -GATEWAYFACILITY NUMBER:
107209200
ADMINISTRATOR:WARD, ROSALINDFACILITY TYPE:
735
ADDRESS:587 GATEWAY AVETELEPHONE:
(559) 322-9183
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY: 4CENSUS: 4DATE:
09/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rosalind Ward, Administrator TIME COMPLETED:
09:20 AM
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Licensing Program Analyst (LPA) B. Miranda and Licensing Program Manager (LPM) S. Moua conducted a follow-up Pre-licensing Inspection. LPA and LPM met with Administrator Rosalind Ward. The pre-licensing visit is to confirm corrections made after the 4/19/22 inspection.

LPA and LPM confirmed that there are 4 residents at the facility. Care plans for the 4 residents were reviewed.

Comp III was previously completed. All pre-licensing requirements have been met. Exit Interview conducted.

SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: See Moua
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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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