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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366403784
Report Date: 01/08/2024
Date Signed: 01/08/2024 04:17:23 PM

Document Has Been Signed on 01/08/2024 04:17 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
, 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:
01/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Lisa Rawles, house managerTIME COMPLETED:
04:19 PM
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Licensing Program Analyst (LPA) Anna Bueno made an unannounced visit to the facility to conduct a required annual inspection. LPA identified herself to house manager Lisa Rawles who was advised of the purpose of the visit. Rawles phoned administrator Vicki Estelle.

LPA Bueno and house manager Rawles toured the interior and exterior part of the facility. The facility has no bodies of water. The backyard has a gazebo with seating. LPA observed the side gate unlocked and free of obstruction. The facility has a working telephone for use. The facility fire extinguisher was last inspected on 07/17/2023. House manager Rawles tested smoke alarms and LPA tested carbon monoxide detector. All units were found to be in working order. Medications and facility files are kept in centralized locked areas. Sharps, toxins, and cleaning agents are kept secured.

The following were observed of the physical plant:
Client Bedrooms and Bathrooms: LPA Bueno and house manager Rawles observed all bedrooms to have the required bedding and furniture, such as, clean mattresses/linen, sufficient storage space, chairs, and lighting. The facility had a supply of additional linens. LPA and DSP observed bathroom appliances were operating in safe and sanitary conditions. The facility keeps a supply of hygiene provision locked.
Kitchen and Dining Areas: LPA and staff inspected the kitchen and found appliances, dishes, glasses, and utensils were in good condition and stored in a safe manner. LPA observed at least a two (2) days supply of perishable food items and seven (7) days supply of nonperishable food items.
Common (living/activity) areas: LPA observed adequate seating throughout the facility. The facility keeps a supply of activities for the clients. House rules and CDSS complaint poster are posted for visitors to view.

The following records were inspected:
Client Records: LPA inspected four client files and found current required documents including but not limited to, signed and dated clients' rights, admissions agreement, physician's report, and needs and services plan.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2024
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: UNIVERSITY LIGHTHOUSE
FACILITY NUMBER: 366403784
VISIT DATE: 01/08/2024
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Staff Records: LPA reviewed all staff files and found current first aid and CPR training. The administrator certificate is current.
Centralized Medication: LPA reviewed four client medications and found that all scheduled medication is being administered as prescribed.
LPA Bueno and house manager Rawles observed emergency provisions. LPA observed the facility emergency disaster plan and reviewed required disaster drills.

No deficiencies were issued during today's visit. A technical advisory was issued for the facility to maintain a printed list of completed staff training, include mandated reporter/abuse reporting. An exit interview was conducted where this report was discussed with and a copy was provided to house manager Rawles at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC809 (FAS) - (06/04)
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