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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006100
Report Date: 04/24/2023
Date Signed: 04/24/2023 11:21:33 AM

Document Has Been Signed on 04/24/2023 11:21 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
ORANGE & INLAND A/SC, 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:
04/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Jennifer DevoreTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for completing a required annual inspection. LPA arrived at facility was greeted at the door and granted entry. LPA met with Katie Carlson and explained the nature of the visit. Jennifer Devore, Program Director arrived shortly after and met with LPA. Two (2) client currently reside at this location.

LPA began the tour of the inside and outside of the facility. LPA toured the kitchen and food storage areas. Food supply adequately meets requirements for a two day supply of perishables and seven day supply of non-perishables food on hand. Disinfectants, cleaning solutions and poisons are inaccessible to clients, stored in storage closet. Lighting is sufficient to ensure comfort and safety. Hot water temperature measured 120.1 Fahrenheit degrees. All toilet, hand washing, and bathing facilities are safe and sanitary. All linen is clean and in good repair. There is ample clean linen for additional use. The staff is enough to meet client’s needs. The facility is maintained in good repair. The furnishings accord clients a safe, healthful, and comfortable home. Medications are stored centrally and locked to assure client safety, locked in medication room. Disaster drill are conducted once a month. LPA toured the outside parameters of the facility and observed outdoor passageways are free of obstruction. LPA reviewed two client and two staff files during this review. All employees have a criminal record clearance. All the required documentation was present and current in all files reviewed.

Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Program Director and a copy of this report was provided and left at facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2023
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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