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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804006
Report Date: 09/12/2022
Date Signed: 09/12/2022 01:46:14 PM

Document Has Been Signed on 09/12/2022 01:46 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
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: 4DATE:
09/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator, John Francois Delos ReyesTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Bright Future Care Home for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Administrator, John Francois Delos Reyes, and was granted access into the facility.

LPA and Administrator toured the facility and found the facility to be clean and well organized. Grounds free of any apparent hazards. All exits unobstructed. Smoke; fire; carbon monoxide were tested and found to be operational. Hot water temperature measured at 118 F degrees in bathrooms. Fire extinguisher was dated for May 2022. Disinfectants and medications locked and stored away. First Aid kit was found to be appropriate during the inspection. Fresh and non-perishable food in adequate supply. No bodies of water on premises. No firearms stored at facility during the inspection. Sufficient linens and bedding for the clients were observed. Bathrooms clean and adequately stocked. Medications were stored and inaccessible to clients according to regulations. Disaster drill log current. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the inspection. Dangerous items were stored inaccessible to clients. There was a supply of cleaners, hygiene products and paper products available for clients. The bathroom designated for clients at the facility were supplied with individual paper towels; hand soap dispenser was available. All client’s bedrooms have lighting & appropriate furnishings, and facility has mattress pads available for clients as required by Title 22 Regulations.

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has sufficient PPE in the garage. Facility is N95 Fit tested which occurred on June 2, 2022.

(Report continued on LIC 809C)
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2022
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BRIGHT FUTURE CARE HOME
FACILITY NUMBER: 486804006
VISIT DATE: 09/12/2022
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LPA requested the following documents:

LIC 500- Personnel Report
LIC 308- Designation of Responsibility
LIC 309- Administrative Organization
LIC 400- Affidavit regarding Client Cash Resources
Updated facility sketch
Updated Emergency Disaster Plan (LIC 610D)
Surety Bond
Most up-to-date Liability insurance
Control of Property
Register of residents

No deficiencies were observed or cited during today's Required 1- Year inspection. Exit interview was conducted and a copy of this report was given to the facility Administrator, John Francois Delos Reyes.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
LIC809 (FAS) - (06/04)
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