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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525001287
Report Date: 05/07/2024
Date Signed: 05/07/2024 11:04:33 AM

Document Has Been Signed on 05/07/2024 11:04 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LIGHTHOUSE LIVING SERVICESFACILITY NUMBER:
525001287
ADMINISTRATOR/
DIRECTOR:		THUEMLER, GINGERFACILITY TYPE:
775
ADDRESS:22825 ANTELOPE BLVD., #FTELEPHONE:
(530) 737-6089
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 38CENSUS: DATE:
05/07/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Ruby Kirk - staffTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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05/07/2024 10:30 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Ruby Kirk. The purpose of this visit was to conduct interviews related to an incident that occurred at another facility.

LPA interviewed 1 client during the visit.

No deficiencies cited. Exit interview conducted and a copy of the report was provided.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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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