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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006165
Report Date: 08/29/2024
Date Signed: 09/06/2024 02:11:18 PM

Document Has Been Signed on 09/06/2024 02:11 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ABLELIGHT, INC. -- OSPREYFACILITY NUMBER:
306006165
ADMINISTRATOR/
DIRECTOR:		KUM, JENNIFERFACILITY TYPE:
740
ADDRESS:24411 OSPREY STREETTELEPHONE:
(949) 837-5385
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 4CENSUS: 4DATE:
08/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Steven Martinez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the reason of the visit. Facility administrator Jill Bonnin was notified of the visit via telephone abut could unfortunately not come in person to assist. Fellow Ablelight administrator Steven Martinez was dispatched instead and assisted with the visit.

During the inspection, LPA and facility staff conducted a tour of the physical plant and observed the following: The facility is a one story home with four private bedrooms and one staff admin office in addition to the facility's common living areas. There are two shared bathrooms, observed to be equipped with grab bars and slip mats. All resident bedrooms have the required furnishings. LPA observed all beds have linens and blankets. Three out of four beds are equipped with half rails for postural support. Physician orders for all three residents are present in the resident files.

There are currently four residents admitted to the facility, three of which are away at day program at the time of the visit. Bathrooms faucets and toilets are operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Fire and emergency drills have been conducted regularly.

LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food. Smoke and carbon monoxide detectors tested operational. Fire extinguishers present are observed to be fully charged with up-to-date maintenance tags.

There is adequately shaded outside space with outdoor furniture present. There are self-latching gates on both sides of the house and routes of egress are free of obstructions.
CONTINUED ON FORM LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ABLELIGHT, INC. -- OSPREY
FACILITY NUMBER: 306006165
VISIT DATE: 08/29/2024
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CONTINUED FROM FORM LIC809

Medication, sharp items and cleaning supplies were confirmed to be inaccessible throughout the physical plant. The medication central storage was also observed to be secure and reviewed for accuracy during the visit. LPA reviewed four resident files and seven staff files. Resident records include all necessary components. All staff members are confirmed to be cleared and associated with this particular licensed location.

Based on the observations made during today’s inspection, no deficiencies are being issued per Title 22 Division 6 of the California Code of Regulations. A Technical Assistance advisory note is provided with a consultation on physician reports. An exit interview was conducted, and a copy of this report along was left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC809 (FAS) - (06/04)
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