565850302-1-10-2025-29-AS-KDUK-DCSUZL-20250110150144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850302
Report Date: 01/10/2025
Date Signed: 01/10/2025 03:01:53 PM

Document Has Been Signed on 01/10/2025 03:01 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	LIGHTFULLY - HALO		FACILITY NUMBER:	565850302
ADMINISTRATOR/ DIRECTOR:	YVETTE LLANOS		FACILITY TYPE:	772
ADDRESS:	949 EL SEGUNDO DRIVE		TELEPHONE:	(805) 852-5457
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY: 6		CENSUS: 5	DATE:	01/10/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:32 PM
MET WITH:	Evan Sahn & Jane Alt		TIME VISIT/ INSPECTION COMPLETED:	03:05 PM

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Licensing Program Analyst (LPA) Kelly Dulek made an unannounced case management visit regarding a self-reported incident on the relocation of 5 clients from Lightfully – Sunrise – License #198320254 to Lightfully – Halo License #565850302 due to mandatory evacuation orders from Fire Advisory. LPA initially met with facility staff and explained the reason for today’s visit. LPA was informed that the Lightfully – Halo location does not have any clients currently, therefore only clients and staff from Lightfully – Sunrise are currently present at the facility.

During the visit, LPA Dulek along with facility staff, conducted a health and safety check and no concerns were observed. Clinical Director/Administrator Jane Alt from Lightfully – Sunrise was initially in session but joined the visit shortly after the facility tour. LPA also met with Primary Therapist Evan Sahn during the visit. LPA reviewed resident and staff rosters for the facility.

Per interview with the facility management, 5 clients have been relocated to Lightfully – Halo. The facility has sufficient beds, hygiene supplies, bedding, linens, and everyone has a designated room. The facility contains 3 (three) shared client rooms and 4 (four) restrooms. The facility has a sufficient 2-day perishable and 7-day non-perishable food supplies. Facility Management noted that there was a Public Safety Power Shutoff (PSPS) at this location for about a day and a half. Power was restored on 01/09/2025 in the afternoon. During the PSPS, the facility utilized food delivery services and have since replaced perishable foods that may have been spoiled due to the power shut off. Medications of the Lightfully – Sunrise clients have been transferred to Lightfully – Halo and are stored in the locked medication cart in the locked nursing office. All MARs and client files are stored electronically; therefore staff have access to Lightfully – Sunrise documents at this location. All client personal belongings have been relocated to this location. All Lightfully – Sunrise clients are fully ambulatory and use no assistive devices.

Facility Management stated they were able to fill medications using a local pharmacy during the time of relocation. The facility also has licensed LVN on staff to care for clients’ health care needs. At this time,

Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LIGHTFULLY - HALO	FACILITY NUMBER: 565850302
	VISIT DATE: 01/10/2025

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Lightfully – Sunrise has paused all admissions due to the evacuation orders and temporary relocation. Management anticipates remaining at this location for at least another week, depending on clearance from local fire officials and potential professional cleaning of the Lightfully – Sunrise location.

There is sufficient staffing available to provide care for clients. Facility Management confirmed all families and responsible parties have been notified about the relocation either via calls, texts, or emails.

As there were no Lightfully - Halo clients, the current location will not be affected by this relocation.

An exit interview was conducted and a copy of this report was provided to Primary Therapist Evan Sahn.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

LIC809 (FAS) - (06/04)

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