191222083-8-30-2023-29-AS-EPEI-CV7VWB-20230830164741

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191222083
Report Date: 08/30/2023
Date Signed: 08/30/2023 04:48:01 PM

Document Has Been Signed on 08/30/2023 04:48 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: 26	DATE:	08/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Gabriela Visovan, Administrator		TIME COMPLETED:	05:00 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. At 9:30 a.m., the LPA met with staff and explained the reason for it visit. At 9:55 a.m., the Administrator arrived at the facility. At 10:21 a.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: 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 10:34 a.m., hot water measured at 105.2-degree Fahrenheit. BEDROOMS: The LPA observed multiple resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:26 a.m., hot water measured between 105.6 and 108.5-degree Fahrenheit in multiple restrooms. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. 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: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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 3

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: 08/30/2023

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

COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers throughout the facility to be fully charged and last serviced on 02/06/2023. Fire alarm system/ emergency lighting was observed and was last tested on 02/2023. At 3:52 p.m., the carbon monoxide detector was tested and functioned properly. The LPA observed cameras installed in the hallways and common areas. All exits have functioning auditory devices and were operational at the time of the visit. Required postings were observed in the hallway. Medications and first aid kits are located in a locked medication room.

OUTDOOR SPACE: At 10:36 a.m., the LPA observed the courtyard area, which has a covered outdoor area for resident use. Passageways and exits were free and clear from obstruction. There is a gate on the side of the facility designated for an emergency exit. The laundry units are located in the laundry room near the courtyard. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the janitor room and a storage room.

Between 10:54 a.m. and 11:45 a.m., the LPA conducted interviews with five (5) out of twenty-five (25) residents and four (4) staff.

RECORD REVIEWS: Between 2:26 p.m. and 3:06 p.m., the LPA conducted a file review for five (5) residents and five (5) staff and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order.

Between 3:09 p.m. and 3:25 p.m., the LPA conducted a review of medication and medication documentation with Administrator for five (5) out of twenty-five (25) residents and observed that all medications were properly documented and assisted with as prescribed.

Copy of valid liability insurance and Facility Emergency Plan was provided to the LPA during the visit.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3