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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804184
Report Date: 11/07/2023
Date Signed: 11/07/2023 02:01:01 PM

Document Has Been Signed on 11/07/2023 02:01 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 CHOICE CARE HOMEFACILITY NUMBER:
486804184
ADMINISTRATOR:DALANON, GRISSELFACILITY TYPE:
740
ADDRESS:293 ARROWHEAD DR.TELEPHONE:
(707) 770-8046
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 4CENSUS: 0DATE:
11/07/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator, Grissel Dalanon
Licensee, Arnell Silverio
Licensee, Dean Gerald
TIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Farhaan Sarangi arrived announced at Bright Choice Care Home for the purpose of conducting a Pre-Licensing Inspection. LPA was greeted at the door by Administrator, Grissel Dalanon and Licensees, Arnell Silverio and Dean Gerald. The facility is approved for 4 non-ambulatory residents with 0 bedridden and 0 ambulatory. Administrator presented the LPA with the Administrators Certificate for Residential Care for the Elderly (Standard Certificate #6063576740 with an expiration of 08/04/2024). First Aid Certificate was observed for the Administrator that expires on March 7, 2024.

LPAs, Administrator and Licensees toured the one story facility. LPA observed the facility to be clean, safe and sanitary with all exits free from obstruction. Outdoor shed was observed in the backyard and had additional storage and no evidence of staff or residents residing in the shed. Fire Extinguishers were found to be last charged on July 2023. All smoke detectors and carbon monoxide detectors were tested and found to be operational at the time of the Pre-Licensing inspection. Hot water temperature measured at 105 degrees in 2 of 2 residents bathrooms and is within Title 22 regulations. Sample food menu was observed on the refrigerator. LPA observed sufficient perishable and non-perishable foods located in the refrigerator and pantry. There were ample space for personal hygiene products, bedding and linens, utensils, dishes, and cook ware. Resident records, personnel records and medications will be locked and in separate cabinets which will be inaccessible to residents in care. Hazardous items and toxins are kept locked and inaccessible to residents in care. Facility has a first aid kit which was inspected and found to be appropriate during the Pre-Licensing inspection. There is an outdoor space for activities with a shaded area for residents in care. All staff will be trained in the Emergency Disaster Plan and COVID-19 Infection Control Practices. Emergency Disaster plan was discussed with the Administrator. However, Emergency Disaster Plan will need to be updated (See LIC 9102-Technical Advisory). Component III was waived due to already being licensed in another County. Exit interview was conducted, and a copy of this report was given to the Licensees. LPA will forward this report to the assigned Application Analyst in our Department; The Application Analyst will notify the Applicant of the status of the application.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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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