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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803971
Report Date: 07/03/2025
Date Signed: 07/03/2025 12:25:48 PM

Document Has Been Signed on 07/03/2025 12:25 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:
07/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Angelie Dean-House Manager and Administrator Princess Diana Silverio TIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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At approximately 9:40 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-Year visit and met with house manager/caregiver Angelie Dean who called administrator Princess Diana Silverio, who, by phone reported Angelie Dean has designation of facility responsibility and could help to begin the inspection. Administrator Silverio arrived at approximately 10:30 AM. LPA was informed there are four (4) residents in care with two (2) away in day programming and one (1) resident on hospice and another resident was present.

Facility is a Residential Care Facility for the Elderly (RCFE) that has vendored residents from North Bay Regional Center (NBRC). Facility has a hospice waiver for three (3), an approved dementia plan and fire clearance for capacity of six (6) residents; five (5) non-ambulatory and one ambulatory.

At approximately 10:35 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 and 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.

Staff rooms containing personal medicines and valuables have lockable doors and it was recommended to administrator to switch key locks to keypad door locks to make compliance with locking staff doors easier.

Facility is noted to have four (4) massage chairs, large television, board games and books for residents.
Continued on 809-C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 LIFE CARE HOME II
FACILITY NUMBER: 486803971
VISIT DATE: 07/03/2025
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Continued from LIC 809...

Facility has supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days, however Administrator reports that the residents do not eat much of the fresh fruit and vegetables they put out.

Facility has a fire extinguisher, which was last inspected July 2024 and is observed to be fully charged and an appointment to be re-inspected is pending. Smoke and Carbon Monoxide detectors were tested and found to operational during inspection. Facility has hardwired alarm bell system.

Facility conducts monthly disaster drills, and the most recent drill was conducted July 2025. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, an emergency water supply. LPA reviewed facility's emergency disaster plan last updated July 2025

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. LPA observed that four (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 appointments.
LPA reviewed residents' P&I records and medications. Medications were centrally stored and locked and a spot check of administration, observed the administration to be accurate.

LPA obtained the follow documents for the Community Care Licensing (CCL) file today including:
1)LIC500-staff roster
2)LIC9020-Registration of facility residents
3)LIC610E-Emergency Disaster Plan
4)Updated Liability Insurance (expires 12/04/2025)
5)LIC308-Designation of Facility Responsibility

No Deficiencies were cited during today's inspection.

Exit interview conducted with Administrator whose signature on this document confirms receipt.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Star Stevenson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC809 (FAS) - (06/04)
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