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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006100
Report Date: 12/14/2022
Date Signed: 12/14/2022 01:27:17 PM

Document Has Been Signed on 12/14/2022 01:27 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 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: 2DATE:
12/14/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Timothy OrtegaTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the post licensing visit. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA met with Operations Manager (OM) Timothy Ortega. LPA and OM toured the facility. The facility is a two story home with 3 client bedrooms (all client bedrooms are shared), living room with a screened fireplace, dining room, family room with a screened fireplace, kitchen, laundry room, 3 car garage and 4 bathrooms, small room used for the medication office and one room used as the staff office and a large activity room on the second floor. LPA observed both fireplaces are screened. LPA observed the kitchen is clean and organized. The stove top lights unassisted. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The fire extinguisher in the garage and the kitchen are both fully charged. LPA observed all client rooms had the required furnishings. All 4 bathrooms are clean and operational. Smoke detectors/carbon monoxide detectors tested operational. The first aid kit is located in the office on the second floor and has all the required elements. The garage is kept locked and used for storage. LPA and OM toured the backyard. No bodies of water observed. The exit gate is alarmed and operational. There is a table with chairs and an umbrella for clients to sit outside. No obstacles or hazards observed inside or outside of the facility. LPA consulted with the OM about continued Covid-19 mitigation and reporting requirements. No deficiencies observed during the visit. 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: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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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