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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525001287
Report Date: 08/20/2024
Date Signed: 08/20/2024 10:55:42 AM

Document Has Been Signed on 08/20/2024 10:55 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: 28DATE:
08/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Ginger Theumler - administratorTIME VISIT/
INSPECTION COMPLETED:
11:00 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
08/20/2024 9:40 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrator Ginger Thuemler and explained the purpose of the visit.

LPA Knight and the administrator toured the facility together to ensure the health and safety of clients who attend program. Areas toured include but are not limited to common areas, two (2) bathrooms, kitchen, and storage areas. Staff and resident files were reviewed. 1 of 4 client files reviewed did not include TB clearance. All employees requiring background checks are cleared.

There is a schedule of recreational activities planned for the clients and clients are given the choice to go out in the community or stay at program each day.

The facility was observed to be at a comfortable temperature. Common area was clean and in good repair. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Food appears to be stored properly. Fire extinguishers fully charged and were inspected in August 2023 and are due for inspection by the fire marshal. Carbon monoxide detectors are operational. There are no pools/bodies of water are on premises. Last disaster drill was conducted in July 2024 which was a fire drill, the facility has been conducting fire drills monthly. Facility has also been providing safety training to the clients including fire safety, earthquake safety and Covid 19 safety.

A violation concerning client records was observed during today's inspection and is documented on the attached LIC809-D.

Exit interview conducted and copy of report was provided to administrator Ginger Thuemler.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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
Document Has Been Signed on 08/20/2024 10:55 AM - It Cannot Be Edited


Created By: Rebecca Knight On 08/20/2024 at 10:44 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LIGHTHOUSE LIVING SERVICES
FACILITY NUMBER: 525001287

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82069(b)(1)
Client Medical Assessments
(b) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review the licensee did not comply with the section cited above in 1 of 4 client records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/03/2024
Plan of Correction
1
2
3
4
Licensee agrees to obtain TB clearance for the client and include it in the client file. Licensee will submit clearance to LPA as proof of correction.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lauren Crocker
LICENSING EVALUATOR NAME:Rebecca Knight
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2