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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803788
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:18:51 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/16/2024 04:18 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BRIGHT MINDS RESIDENTIAL CAREFACILITY NUMBER:
486803788
ADMINISTRATOR/
DIRECTOR:		DEAN, GRISSELFACILITY TYPE:
740
ADDRESS:2598 BOXWOOD LNTELEPHONE:
(707) 386-3888
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 6CENSUS: 5DATE:
10/16/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Kristine Lorenzo, Caregiver/AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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At approximately 10:10 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a case management -- annual continuation inspection and was greeted by Kristine Lorenzo, Caregiver/Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care, two of whom were away at Day Program during today's visit. Facility has a Hospice waiver for three (3) and a Dementia Care Plan but does not currently have any residents in care with dementia or who are receiving hospice care.

At approximately 11:00 PM, LPA initiated a tour of the facility with Caregiver/Administrator and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens and paper and incontinent care products available to residents. Residents' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Resident 1 (R1) was observed in a hospital bed with compression wraps on their feet, and upon interview with them, LPA was informed that that R1 is unable to reposition or transfer to and from the bed without staff assistance or a hoyer lift. Caregiver/Administrator agreed to take R1 to the doctor for an updated LIC602-Physician's Report to verify whether R1's ambulatory status. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a covered seating area in the backyard with outdoor space for activities. LPA observed a locked shed in the backyard which LPA inspected and observed the contents to consist of tools, chemicals, decorations, extra incontinent care products, PPE, a couch and two desks set-up for use as an office space. LPA observed an activity schedule and games, crafting supplies, and other activities available for resident use. Facility has an internet access device (an iPad) and internet service available to residents in care. The telephone was tested an operational during inspection.

Facility's fire extinguisher was observed charged and was last serviced 06/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection.

Continued on LIC809-C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
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)
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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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BRIGHT MINDS RESIDENTIAL CARE
FACILITY NUMBER: 486803788
VISIT DATE: 10/16/2024
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Continued from LIC809C...

Facility conducts monthly disaster drills, and the most recent drill was conducted 10/01/2024. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, and a back-up generator. LPA reviewed facility's emergency disaster plan last updated 07/16/2024.

At approximately 11:30 AM, LPA conducted file review of five (5) resident files and observed the following: five (5) of five (5) resident files reviewed contained all the required documents per Title 22 regulations.

At approximately 1:00 PM, five (5) staff files were reviewed. Five (5) of five (5) staff files reviewed have all of the required paperwork, including CPR and First Aid training certificates and documentation of all required initial and annual training hours.

At approximately 1:45 PM, LPA reviewed medications and medication records which are maintained and stored in compliance with regulation. Caregiver/Administrator states facility and residents' families work together to coordinate medical and dental appointments and transportation to and from visits. Facility does not manage cash resources for residents.

Licensee has submitted paperwork to CCL requesting Kristine Lorenzo be updated as the new facility administrator. Once CCL receives a copy of her Administrator's Certificate, LPA will process the request.

Updated copies of the following documents are to be submitted to CCL within 30 days of this visit:
  • Updated LIC602 - Physician's Report for R1
  • Copy of Physician's order for compression wraps for R1

No deficiencies cited during today's inspection. Exit interview conducted with Caregiver/Administrator whose signature on form confirms receipt of documents.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
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
LIC809 (FAS) - (06/04)
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