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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804006
Report Date: 11/05/2021
Date Signed: 11/05/2021 02:13:37 PM

Document Has Been Signed on 11/05/2021 02:13 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
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:BRIGHT FUTURE CARE HOMEFACILITY NUMBER:
486804006
ADMINISTRATOR:REYES, JOHN FRANCOIS DELOSFACILITY TYPE:
740
ADDRESS:830 DAFFODIL DR.TELEPHONE:
(707) 386-3888
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 4CENSUS: 0DATE:
11/05/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:57 PM
MET WITH:Administrator, John ReyesTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Victoria Willis arrived announced to conduct a Pre-Licensing Inspection and met with Applicant, Arnel Silverio and Administrator, John Reyes.

Upon arrival, LPA observed Covid-19 posters on the front door. Once inside, LPA observed multiple Covid-19 posters and a screening station for Covid-19 symptoms that included masks, hand sanitizer and a thermometer. Facility is a one story residence with four single client bedrooms, a staff room, two and a half bathrooms and common areas. All client rooms are furnished per regulation with a bed, lamp, dresser, chair and bedside table. Bathroom shower has non-skid shower floor and grab bars. Water temperature in bathrooms read at 112 and 118 degrees F which are within regulation of 105 & 120 degrees F. Facility has sufficient items used for cooking and eating. Facility has a locked cabinet in the kitchen used for centrally stored medications and files. Cleaning supplies and toxins will be locked in a cabinet under the kitchen sink and in a cabinet in the garage. Perishable and non-perishable foods observed per regulation. Facility backyard has multiple areas for visiting and activities.

Facility received an approved fire clearance dated September 28, 2021 that allows for four non-ambulatory clients. Combination smoke/Carbon Monoxide detectors were tested and operational. Facility has emergency lighting in hallways. LPA confirmed that contents of the facility First Aid Kit were sufficient and that facility has emergency lighting in case of a power outage.

LPA confirmed that Applicant is familiar with Guardian and has read the most recent Provider Information Notices (PINs) that the department sent out regarding Covid-19 vaccinations and visitation.

Component III is waived due to Applicant being a current Licensee.

LPA will notify Application Unit so application process may proceed.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Willis
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
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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