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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011405838
Report Date: 10/16/2024
Date Signed: 10/16/2024 11:09:16 AM


Document Has Been Signed on 10/16/2024 11:09 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:ABLELIGHT, INC - MOWRYFACILITY NUMBER:
011405838
ADMINISTRATOR:CHRISTINA O QUINTANAR-SANCFACILITY TYPE:
735
ADDRESS:1335 MOWRY AVETELEPHONE:
(510) 505-1245
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:12CENSUS: 12DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tsion Haile Mogesse, Administator TIME COMPLETED:
11:15 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 10/16/2024, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen conducted an unannounced case management visit regarding an incident report that was reported to CCLD on 09/04/2024. LPAs met with Administrator, Tsion Haile Mogesse, and explained the purpose of the visit.

The incident report indicated that approximately on 09/03/2024 at 6pm, C1 was not given their medication. C1’s family and doctor was notified immediately after finding out about the medication error. Administrator indicated that during this time the facility was in the process from moving from a paper Medication Administration Record (MAR) to electronically MAR. Administrator stated that after this incident occurred, staff was trained verbally on passing medications.

Moving forward, the preventative plan implemented two staff per shift checking the MAR daily along with the administrator reviewing the MAR throughout the day and documenting it.

No deficiency cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-4201
LICENSING EVALUATOR NAME: Patricia ManaloTELEPHONE: (916) 432-7785
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024
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 1