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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700281
Report Date: 02/06/2025
Date Signed: 02/06/2025 07:46:05 PM

Document Has Been Signed on 02/06/2025 07:46 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LIGHTHOUSE MANORFACILITY NUMBER:
502700281
ADMINISTRATOR/
DIRECTOR:
RABANG, CLAIREFACILITY TYPE:
740
ADDRESS:2413 BECKER CTTELEPHONE:
(209) 345-6301
CITY:MODESTOSTATE: CAZIP CODE:
95358
CAPACITY: 6CENSUS: 5DATE:
02/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Administrator Claire Rabang TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst Jason Lund arrived unannounced to conduct an annual/required visit. LPA was met by facility staff and later with Administrator Claire Rabang and explained the reason for the visit.
Census: 5
LPA Lund & Administrator Claire Rabang toured/inspected the facility and grounds including but limited to kitchen, dining area, office, common room, bathrooms, resident and staff bedrooms, garage, and yard. LPA observed that there was adequate furniture and lighting for the residents. There were 7-days of non-perishables and 2- days of perishables on hand. Knives were locked in a drawer adjacent to the sink. Toxic items were locked in a separate cabinet above the counter. The fire extinguisher was located in the kitchen/dining area and observed to have been recently inspected on 11/13/2024 by the local fire extinguisher company and in compliance at this time. Medications were locked and secured in a cabinet. Refrigerated medications were also locked in a small refrigerator in the office. The Medication Administration Record and dispensing log were reviewed and observed to be in compliance at this time. Grab bars and handrails were observed to be present and functional along with non-skid surfaces in the restrooms and shower area. Bedrooms were inspected and observed to be in good repair at this time. Resident bedrooms were observed to contain adequate furniture, including night stands and night lights, in order to meet the needs of the residents at this time. LPA toured the exterior grounds and observed the facility to be free and clear of obstacles. The garage was also inspected and had locked cabinets for cleaning supplies and other toxic items. LPA reviewed 3 resident and 2 staff records. Resident files were found to be complete and current. Facility is conducted staff training as required.
No deficiencies observed or cited during visit. Exit Interview and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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