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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006100
Report Date: 04/21/2022
Date Signed: 04/21/2022 10:38:48 AM

Document Has Been Signed on 04/21/2022 10:38 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 RECOVERYFACILITY NUMBER:
306006100
ADMINISTRATOR:MORRIS-HERNANDEZ, ERINFACILITY TYPE:
772
ADDRESS:27732 PASEO BARONATELEPHONE:
(407) 616-8872
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 6CENSUS: 0DATE:
04/21/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Erin Morris-HernandezTIME COMPLETED:
10:48 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Joseph Alejandre and Celine De Perio made an announced visit to conduct the second pre-licensing visit. LPAs were greeted and granted entry by the Administrator Erin Morris-Hernandez. LPAs and the Administrator toured the facility.

LPA observed the following items have been corrected. The hot water temperature measured 110,6 degrees Fahrenheit. LPA observed the roofing tiles stacked next to the front exit gate have been removed. LPA observed the PUB 475 poster, See Something Say Something poster is posted by the entrance of the facility next to the front door. LPA observed the Front and rear exit gates and the front door have an auditory alarm that sounds when the doors are opened. LPA observed the front exit gate is now self closing. LPA observed the toilet in the master bathroom downstairs is operational. LPA observed the ceiling fan in bedroom number 2 has 3 lights bulbs and they are all operational and the fan works. Administrator was reminded that it is required to notify the LPA, within 5 business days of admitting the first client. This notification may be done by phone, email or fax.

Administrator was notified that the final application approval and facility license will be issued by the Centralized Applications Bureau (CAB) in Sacramento. The physical plant is ready to accept clients. LPA observed no deficiencies at the facility. LPA informed the Administrator that once the facility is licensed a post licensing visit will be conducted within 90 days of licensure. Exit interview was conducted and a copy of this report was provided to Administrator Erin Morris-Hernandez.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2022
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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