<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604510
Report Date: 01/16/2024
Date Signed: 01/16/2024 10:21:21 AM

Document Has Been Signed on 01/16/2024 10:21 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LORENZO'S LIGHTHOUSEFACILITY NUMBER:
374604510
ADMINISTRATOR:GERONIMO, MARICONFACILITY TYPE:
735
ADDRESS:4496 G STTELEPHONE:
(916) 835-3979
CITY:SAN DIEGOSTATE: CAZIP CODE:
92102
CAPACITY: 4CENSUS: 4DATE:
01/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Maricon Geronimo, LicenseeTIME COMPLETED:
10:35 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/16/2024, at about 09:10 AM, Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Bryan Padilla, Caregiver. Licensee, Maricon Geronimo, later joined LPA during the inspection.

According to the facility’s license, the facility serves four (4) developmentally disabled, ambulatory clients, age range 18 through 59. On the day of the visit, LPA observed one (1) client, as the others were at their Adult Day Program.

During the inspection, LPA toured the interior and exterior of the facility and observed each client’s room. The facility was organized, kempt and in good repair. The facility had no offensive odors. Pathways inside the property were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

There were at least two days of perishable food, and at least seven days of non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. Medications were labeled, as required, and stored in locked areas.

No pools or bodies of water were observed on the premises. Per Mr. Padilla, no firearms or ammunition are kept at the facility. Emergency lighting, and facility telephone were all working. LPA observed carbon monoxide, smoke detectors, and fire extinguishers and all were serviceable and operational. First aid kit(s) were observed. Required licensing postings were observed in visible areas of the facility. Hot water temperatures measured at 119.9 and 116.6 in sinks accessible to clients. Bathroom toilets, sinks and showers were observed to be in good service and operational.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: LORENZO'S LIGHTHOUSE
FACILITY NUMBER: 374604510
VISIT DATE: 01/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
[Continued from LIC809]


LPA interviewed clients and reviewed staff and client records/files. Staff records contained CPR/First Aid certifications, health screenings and fingerprint clearances. LPA reviewed client files which contained the required documents and were maintained in a secure area in the facility. No deficiencies were cited during today's annual inspection.

An exit interview was conducted with Licensee, Geronimo, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2