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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209208
Report Date: 11/15/2022
Date Signed: 11/15/2022 10:31:02 AM

Document Has Been Signed on 11/15/2022 10:31 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. -- DEWITTFACILITY NUMBER:
107209208
ADMINISTRATOR:MASK, ITASKAFACILITY TYPE:
740
ADDRESS:898 N. DEWITT AVE.TELEPHONE:
(559) 322-9183
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 4CENSUS: 4DATE:
11/15/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Rosalind Ward, AdministratorTIME COMPLETED:
10:35 AM
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On 11/15/22, Licensing Program Analyst (LPA) M. Yang conducted an announced Pre-licensing / Component III Inspection. LPA introduced self, stated the purpose of the visit, and was allowed entry into the facility. LPA met with Rosalind "Ros" Ward, Administrator. Licensee is converting facility from ICF to RCFE. Licensee plans to retain all current residents. LPA toured the facility with Administrator. There were four residents present during LPA arrival. One resident left to day program during inspection.

The facility is a four bedroom and three-bathroom home and fire clearance were granted for four Non-Ambulatory for a total capacity of four. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. LPA reviewed resident record and observed Admission Agreements and Physician Reports. First aid kit was observed and contained all required items. A fire extinguisher was observed and had a service date of 06/20/2022. Hot water temperature ranged between 105.4 to 110.7 degrees F in bathroom sinks. Bedrooms were observed to have the required furnishing and have adequate lighting. LPA observed an extra supply of bed linens and personal hygiene products. Kitchen was toured and observed to have dishes, plates, and utensils. Knives will be kept locked and secure in the kitchen drawer. Medications were kept locked and inaccessible to clients in care. Cleaning supplies and chemicals observed to be locked and secure in garage cabinet. Facility have 30-day PPE supplies. Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching and self-closing. Smoke detectors and carbon monoxide were observed to be operational during this inspection. Facility phone number will be (559) 323-8495.

Component III was conducted during today's pre-licensing visit.

I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued. A copy of this report was provided to Administrator.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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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