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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005892
Report Date: 09/23/2022
Date Signed: 09/23/2022 11:39:51 AM

Document Has Been Signed on 09/23/2022 11:39 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, 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: 5DATE:
09/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Tim OrtegaTIME COMPLETED:
11:48 AM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Lead Technician (LT) Tim Ortega. LPA explained the reason for the visit. LT and LPA toured the facility. Facility is a 2 story home with, 3 bedrooms, 3 bathrooms, living room, kitchen, dining room, staff room, activity room, staff office (upstairs) laundry room and a 3 car garage. LPA observed all the client bedrooms had the required furnishings. LPA observed all fire extinguishers are fully charged (one in the garage, one in the upstairs hallway and one in the kitchen). Smoke detectors/carbon monoxide detectors tested operational. All 3 bathrooms were clean and operational. LPA observed the master bathroom windows had screens. LPA observed the doorbell chime had a cover. LPA observed the fireplace in the living room is screened and the fireplace in the staff room is screened. LPA observed a 2 day perishable and a 7 day non-perishable food supply in the kitchen. The stove lights unassisted. LPA observed knives and medications are kept secured in the staff office. LPA and LT toured the garage. The garage is kept locked and used for storage. No obstacles or hazards observed in the garage. LPA toured the backyard of the facility. No bodies of water observed. There's a fountain that is empty in the backyard. There's a patio with tables and chairs for clients to sit outside. The exit gate on the side of the facility is operational. No obstacles or hazards observed in the backyard. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. LPA consulted with facility staff concerning continued Covid-19 mitigation procedures. 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: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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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