191222083-7-19-2022-29-AS-EPEI-CGGUMM-20220719154235

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191222083
Report Date: 07/19/2022
Date Signed: 07/19/2022 03:43:26 PM

Document Has Been Signed on 07/19/2022 03:43 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	LIGHTHOUSE, THE		FACILITY NUMBER:	191222083
ADMINISTRATOR:	GABRIELA VISOVAN		FACILITY TYPE:	740
ADDRESS:	10406 MAGNOLIA BLVD.		TELEPHONE:	(818) 766-3764
CITY:	TOLUCA LAKE	STATE: CA	ZIP CODE:	91601
CAPACITY:	49	CENSUS: 27	DATE:	07/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:17 PM
MET WITH:	Gabriela Visovan, Administrator		TIME COMPLETED:	03:48 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. LPA was greeted and screened by staff. At 2:17 p.m., the LPA met with the Administrator and explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures. At 2:36 p.m., the LPA, along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: At 2:40 p.m., the LPA observed the kitchen/dining area. Knives are stored in the locked kitchen which is inaccessible to residents. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 2:42 p.m., hot water measured at 108.5-degree Fahrenheit. BEDROOMS: The LPA observed multiple resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 2:38 p.m., hot water measured at 105.3-degree Fahrenheit. Additionally, one of the common restroom water temperature measured at 106.0 degree Fahrenheit. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. At 2:54 p.m., the LPA observed residents and staff playing a game of bingo. The LPA observed the fire extinguishers throughout the facility to be fully charged and last serviced on 02/07/2022. Signs are posted throughout facility to promote handwashing, cough/sneeze etiquette, and physical distancing. Fire alarm system was observed and was last tested on 02/15/2022. The LPA observed cameras installed in the hallways and common areas. Continued on LIC 809-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LIGHTHOUSE, THE	FACILITY NUMBER: 191222083
	VISIT DATE: 07/19/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Medications and first aid kits are located in a locked medication room. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the janitor room near the kitchen area. The laundry units are located in the laundry room near the courtyard.

OUTDOOR SPACE: At 2:46 p.m., the LPA observed the courtyard area, which has a covered outdoor area for resident use. Passageways were free and clear from obstruction. There is a gate on the side of the facility designated for an emergency exit.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. The LPA observed a 30-day supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. At 2:26 p.m., the LPA conducted the Infection Control mitigation module with the Administrator.

No deficiencies were observed at this time. Exit interview conducted with the Administrator. Report issued and a copy of the report will provided via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2