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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366403784
Report Date: 02/25/2022
Date Signed: 02/25/2022 03:49:15 PM

Document Has Been Signed on 02/25/2022 03:49 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:UNIVERSITY LIGHTHOUSEFACILITY NUMBER:
366403784
ADMINISTRATOR:DAVID NEALFACILITY TYPE:
735
ADDRESS:307 EAST "C" STREETTELEPHONE:
(909) 824-3255
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY: 4CENSUS: 4DATE:
02/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Vicky Vicki Estelle and Lisa RawlesTIME COMPLETED:
03:52 PM
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Licensing Program Analysts (LPAs) Anna Bueno and Ryan Gardner conducted an unannounced visit to the facility for an annual inspection. LPAs met with Administrator Vicki Estelle and care taker Lisa Rawles.

LPAs toured the facility inside and out. The facility has no bodies of water. The facility has charged fire extinguishers, smoke alarms, and carbon monoxide detectors. Cleaning supplies, medications, and sharps were kept in a safe and locked place. Medications were kept in a locked cabinet. LPAs observed more two (2) days of perishable food items and seven (7) days of nonperishable food items. Facility had a supply of additional linen and hygiene items.

LPAs observed that the facility has a mitigation plan to mitigate the spread of COVID-19 in the facility. One central entry point and sign-in policy has been designated for universal entry screening. Routine symptom screening has been initiated at entry for all staff, clients, and visitors. LPAs observed hand sanitizer throughout the facility and 30 day supply of PPE housed in the private room. All clients have at least a 30 day supply of medications.

Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report was discussed, and a copy of this report was also provided to the Administrator at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
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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