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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209201
Report Date: 09/29/2022
Date Signed: 09/29/2022 10:44:17 AM

Document Has Been Signed on 09/29/2022 10:44 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ABLELIGHT, INC. - ROGERSFACILITY NUMBER:
107209201
ADMINISTRATOR:MASK, ITASKAFACILITY TYPE:
740
ADDRESS:861 N ROGERS AVENUETELEPHONE:
(559) 323-7295
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 4CENSUS: 4DATE:
09/29/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Itaska Mask, AdministratorTIME COMPLETED:
10:50 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 09/29/22, Licensing Program Analyst (LPA) M. Yang conducted an announced Pre-licensing / Component III Inspection. LPA introduced self, stated the purpose of the visit, and was allowed entry into the facility. LPA met with Itaska Mask, Administrator. Licensee is converting facility from ICF to RCFE. Licensee plans to retain all current clients. Administrator states there are three clients who over the age of 60 with one waiver for one client under the age of 60. All four clients present during LPA arrival. Three residents left to day program during inspection.

The facility is a 4 bedroom and 3 bathrooms home and fire clearance were granted for 4 Non-Ambulatory for a total capacity of 4. Facility phone number will be (559) 323-7295. LPA toured the facility with Administrator. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. First aid kit was observed and contained all required items. A fire extinguisher was observed and had a service date:06/24/2022. LPA observed an extra supply of bed linens and personal hygiene products. Kitchen was toured and observed to have dishes, plates, and utensils. Knives will be kept locked and secure in the kitchen drawer. Medications were kept locked and inaccessible to clients in care. Bedrooms were observed to have the required furnishing and adequate lighting. Hot water temperature ranged between 105.3 to 107.4 degrees F between three residents’ bathroom sinks. Cleaning supplies and chemicals observed to be locked and secure in garage cabinet. Facility have 30-day PPE supplies and Mitigation plan. Outside toured and observed free of obstructions. Side gate observed to be self-latching and self-closing. Smoke detectors and carbon monoxide were observed to be operational during this inspection. Clients’ records were reviewed. LPA observed clients’ Admission Agreements and Physician Reports.

Component III was conducted during today's pre-licensing visit.

I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued. A copy of this report was provided to Administrator.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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