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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005892
Report Date: 10/29/2021
Date Signed: 10/29/2021 02:24:15 PM

Document Has Been Signed on 10/29/2021 02:24 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:FIRST LIGHT RECOVERY LLCFACILITY NUMBER:
306005892
ADMINISTRATOR:DEVORE, JENNIFERFACILITY TYPE:
772
ADDRESS:31211 CASA GRANDE DRIVETELEPHONE:
(407) 616-8872
CITY:SAN JAUN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 6CENSUS: 4DATE:
10/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Erin HernandezTIME COMPLETED:
02:38 PM
NARRATIVE
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Licensing Program Analyst (LPA's) Joseph Alejandre and Jerome Haley made an unannounced visit to conduct the required annual inspection. LPAs were greeted and granted entry by staff. LPAs observed all staff were wearing mask. General Manager (GM) Erin Hernandez led the tour of the facility. LPAs observed all resident bedrooms had the required furniture and had enough space to accommodate the resident and their belongings. LPAs observed the doorbell chime missing the plastic cover. LPAs inspected the bathrooms. All bathrooms were clean and operational. LPAs inspected the kitchen. LPAs observed the facility has a 2-day perishable and a 7-day non-perishable food supply on hand. LPAs observed medication is locked in the office closet. LPAs observed knives are kept locked in the office. LPAs inspected the facility garage. The garage is used for storage and kept secure from residents. LPAs inspected the First Aid kit. The First Aid kit had all the required elements. LPAs toured the backyard of the facility. No bodies of water observed. There's a fountain with the bottom level filled with plants and no water in the top levels of the fountain. There's a sitting area with a table, and chairs in a shaded area for sitting outside. The exit gate on the side of the facility is operational. LPAs observed a missing screen on the master bathroom middle window. Facility has a mitigation plan that is pending approval. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2021
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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