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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222083
Report Date: 08/16/2024
Date Signed: 08/16/2024 01:14:02 PM


Document Has Been Signed on 08/16/2024 01:14 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:LIGHTHOUSE, THEFACILITY NUMBER:
191222083
ADMINISTRATOR:GABRIELA VISOVANFACILITY TYPE:
740
ADDRESS:10406 MAGNOLIA BLVD.TELEPHONE:
(818) 766-3764
CITY:TOLUCA LAKESTATE: CAZIP CODE:
91601
CAPACITY:49CENSUS: 26DATE:
08/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Gabriela VisovanTIME COMPLETED:
01:13 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 08:31 AM. LPA contacted the facility administrator Gabriela Visovan via telephone call. Facility administrator arrived to the facility at approximately 08:50 AM Entrance interview conducted and the reason for the visit was explained.

Beginning at 08:52 AM, the LPA, along with facility administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: There are twenty-seven (27) bedrooms in the facility; all are designated for resident use. LPA and facility administrator toured five (5) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

BATHROOMS: Bathrooms are attached individually to resident rooms. LPA and administrator observed five (5) resident bathrooms. Bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed next to all toilets and in all showers and all were properly secured. The water temperature was measured between 105.4 and 109.7 degrees Fahrenheit, which is in compliance with regulation.

COMMON AREAS: This includes the common room and dining room areas. LPA observed common room to be clean and properly furnished at the time of the visit. The Dining room contained adequate seating and was observed to be clean. Cameras were observed in the common areas and hallways throughout the facility. The LPA observed fire extinguishers throughout the facility to be fully charged and serviced on 02/17/2024. Smoke detectors and carbon monoxide detectors were last tested on 7/31/2024 and were functional at the time of the test.


Report Continued on LIC 809-C
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LIGHTHOUSE, THE
FACILITY NUMBER: 191222083
VISIT DATE: 08/16/2024
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KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. The facility has adequate supply of emergency food and water. The LPA observed one designated cabinet where cleaning supplies are stored locked and inaccessible to residents.

OUTDOOR SPACE: The outdoor space has sufficient patio furniture including shaded tables and chairs for resident use LPA observed the laundry room to be locked and contain detergents and other cleaning supplies. The facility has an emergency exit gate, LPA observed clear passageways for emergency exit use.

RECORD REVIEW: Record review began at 09:35 a.m. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, TB tests, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained the required documents and trainings. Five (5) resident files were reviewed. All resident files reviewed contained all required documentation. No deficiencies were observed during record review.

MEDICATION REVIEW: Medication review began at 10:35 a.m. Medications are stored centrally and securely in the medication room. Medications for five (5) residents were observed. All medications reviewed were documented properly on their centrally stored medication and destruction record sheet. No deficiencies were observed during medication review.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the
facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Last emergency disaster drill was conducted 06/19/2024. The facility’s emergency disaster plan is up to date and adequate.

INTERVIEWS: LPA interviewed five (5) staff and five (5) residents. All residents interviewed stated that the food was of good quality and is provided in sufficient amounts. All residents stated that staff treat them very well and are attentive to their needs. All staff interviewed were knowledgeable on resident rights, their roles and responsibilities, the different forms of abuse and the appropriate reporting procedures for suspected abuse. Report Continued on LIC 809-C

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LIGHTHOUSE, THE
FACILITY NUMBER: 191222083
VISIT DATE: 08/16/2024
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During today’s visit LPA obtained a copy of the facility’s updated LIC500, surety bond, resident roster, and liability insurance.

No deficiencies were cited at the time of the visit. Exit interview conducted. And a copy of the report was provided.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Trevor ByrneTELEPHONE: 747-444-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC809 (FAS) - (06/04)
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