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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803971
Report Date: 07/16/2024
Date Signed: 07/16/2024 02:10:44 PM

Document Has Been Signed on 07/16/2024 02:10 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 LIFE CARE HOME IIFACILITY NUMBER:
486803971
ADMINISTRATOR/
DIRECTOR:		SILVERO, PRINCESS DIANAFACILITY TYPE:
740
ADDRESS:1043 SPARROW LANETELEPHONE:
(707) 386-3888
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 6CENSUS: 4DATE:
07/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Rhodora Lopez, Caregiver/Designated Responsible Party, Arnel Silverio, Licensee, Princess Diana Silverio, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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At approximately 9:30 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a 1-Year Required Visit and met with Rhodora Lopez, Caregiver/Designated Responsible Party. Arnel Silverio, Licensee, was contacted by phone and authorized LPA to begin inspection with Caregiver. Licensee and Princess Diana Silverio, Administrator both arrived shortly after. LPA was informed there are four (4) residents in care; three (3) were away at their Day Program and one (1) conducts Day Program via Zoom and was present during inspection. Facility is a Residential Care Facility for the Elderly (RCFE) with a Hospice waiver for three (3), an approved dementia plan and fire clearance for capacity of six (6) residents; 5 non-ambulatory and one ambulatory.

At approximately 9:45 AM, LPA initiated a tour of the facility and observed the following: Facility is a one-story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed client showers with grab bars an non-slip mats as required. LPA observed a supply of clean linens, incontinent care products, and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable foods and a supply of non-perishable foods. However, LPA observed little to no fresh vegetables in the facility and was informed that the residents decline to eat them. LPA advised Administrator to note this in each residents' service plan so all parties are aware. Medications were centrally stored and locked. There is outdoor space for activities. LPA observed games and an ipad for resident use.

Facility has a fire extinguisher, which was last inspected August 2023 as is not fully charged. Administrator called and scheduled service immediately and will have fire extinguisher fully charged tomorrow, 7/17/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection.

Continued on 809-C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2024
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 4
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 LIFE CARE HOME II
FACILITY NUMBER: 486803971
VISIT DATE: 07/16/2024
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Continued from LIC 809...

Facility conducts monthly disaster drills, and the most recent drill was conducted July 2024. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, an emergency water supply, and a back-up battery/generator. LPA reviewed facility's emergency disaster plan last updated January 2024.

At approximately 11:00 AM, five (5) staff files and four (4) resident files were reviewed. All staff files reviewed have the required CPR and First Aid training certificates, as well as all required initial training hours. All staff files reviewed meet the annual training hours but are lacking some category specific hours. LPA advised Licensee and Administrator and provided them a copy of the regulation for reference. Licensee immediately updated the facility's online training program to bring facility into compliance with annual training requirements. LPA observed that 4 of 4 resident files had all the required documentation per regulation. Licensee states facility coordinates the residents' medical and dental appointments as needed and provides transportation to and from these visits. LPA reviewed residents' P&I records and medications and medication records which are all maintained in compliance with regulation.

No Deficiencies were cited during today's inspection.

Exit interview conducted with Administrator whose signature on this document confirms receipt.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC809 (FAS) - (06/04)
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