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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005892
Report Date: 10/31/2024
Date Signed: 10/31/2024 04:21:13 PM

Document Has Been Signed on 10/31/2024 04:21 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:FIRST LIGHT RECOVERY LLCFACILITY NUMBER:
306005892
ADMINISTRATOR/
DIRECTOR:
SHEA RIDENOURFACILITY TYPE:
772
ADDRESS:31211 CASA GRANDE DRIVETELEPHONE:
(407) 616-8872
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 6CENSUS: 3DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Jennifer DevoreTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Joseph Alejandre and Brandon Lopez made an unannounced visit to conduct the required 1 year annual visit. LPAs were greeted and granted entry by staff. LPAs met with Administrator Jennifer Devore and explained the reason for the visit. Facility is a 2 story home with, 3 bedrooms, 3 bathrooms, living room, kitchen, dining room, staff room, staff office, activity room, laundry room and a 3 car garage. Facility is licensed for 6 ambulatory clients. LPAs and Administrator toured the facility. LPAs observed the See Something Say Something sign (PUB) by the front door. LPAs observed the fire place in the living room is screened. LPAs observed a 72 hour supply of emergency food and water. The sliding door in the living room does not have a sliding screen door. Games and puzzles are stored in the cabinet underneath the staircase. LPAs observed a 2 day perishable and 7 day non perishable food supply in the kitchen. The five burner gas stove top lights unassisted. LPAs and Administrator toured the backyard. No bodies of waters observed. The exit gate on the north side of the house is operational. There is a table with an umbrella with chairs for clients to sit outside. No obstacles or hazards were observed in the backyard. LPAs and Administrator inspected the garage. The garage is kept locked and used for storage. LPAs and Administrator toured the second floor. LPAs observed an emergency evacuation chair at the top of the staircase. LPAs observed medication and sharp objects are kept locked in the staff office. All three client rooms had the required furnishing and bed linens. The bedroom downstairs, which has a bathroom, is missing a window screen in the bathroom. All three bathrooms are clean and operational. Hot water measured 115.8 degrees Fahrenheit in all three bathrooms. LPAs observed the activity room on the second floor has a large table with chairs, couches and chairs for clients to sit at. LPAs observed books, games, and puzzles in the activity room. LPAs observed two windows in the activity room do not have screens. All the fire extinguishers on the first and second floor are fully charged. Smoke detectors/carbon monoxide detectors tested operational. The last fire drill was conducted September, 12, 2024. LPAs reviewed 2 staff files. No discrepancies observed. All staff had the required training, including first aid training. All staff present at the facility are background cleared and associated to the facility. LPAs reviewed 3 client files and medication. No discrepancies observed. LPAs consulted with the Administrator regarding reporting requirements.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: FIRST LIGHT RECOVERY LLC
FACILITY NUMBER: 306005892
VISIT DATE: 10/31/2024
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No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
LIC809 (FAS) - (06/04)
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