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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804184
Report Date: 11/01/2024
Date Signed: 11/01/2024 01:47:09 PM

Document Has Been Signed on 11/01/2024 01:47 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 CHOICE CARE HOMEFACILITY NUMBER:
486804184
ADMINISTRATOR/
DIRECTOR:		AIDA DEANFACILITY TYPE:
740
ADDRESS:293 ARROWHEAD DR.TELEPHONE:
(707) 750-0625
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 4CENSUS: 3DATE:
11/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Aida Dean, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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At approximately 10:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by Aida Dean, Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. Resident 1 (R1) was present during inspection and LPA was informed that Resident 2 (R2) and Resident 3 (R3) were away at their day program. Facility has a Dementia Care Plan, a Hospice waiver for two (2), is approved for all non-ambulatory residents, and is vendorized with North Bay Regional Center (NBRC).

At approximately 10:30 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed two locked sheds in the backyard which LPA inspected and observed the contents of both to consist of tools, chemicals, decorations, and personal items. LPA observed an activity schedule and was informed that the facility plays bingo, watches movies, and plans one-on-one outings between staff and residents where each resident is taken to places they request, such as church, the store, or a restaurant. Facility also hosts holiday parties for the residents and throws a large Halloween and Christmas party in a central location where all twelve (12) care homes attend. Administrator agreed to obtain additional games and activities for residents in care. Facility does not have an internet access device designated for resident use.

Continued on LIC809-C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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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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 CHOICE CARE HOME
FACILITY NUMBER: 486804184
VISIT DATE: 11/01/2024
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Continued from LIC809C...

Administrator agreed to ensure the facility obtains one. Facility has internet service available to residents in care and the telephone was tested an operational during inspection.

Facility's fire extinguisher was observed charged and was last serviced 11/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts monthly disaster drills, and the most recent drill was conducted 10/2024. LPA observed the facility's infection control plan, first aid kit, PPE, and emergency supplies. LPA reviewed facility's emergency disaster plan last updated 10/2024.

At approximately 11:30 AM, LPA conducted file review. Five (5) staff files and three (3) resident files were reviewed. All staff files reviewed have all of the required paperwork including the required CPR and First Aid training certificates and documentation of all required initial training hours. Facility had there first residents placed 8/2024 and that is when the first staff began working as well. Three (3) of five (5) staff files reviewed have proof of already completed annual training. Administrator understands that all staff shall have completed their annual training before the end of their first year of employment. LPA informed Administrator to ensure that all staff health screenings and proof of negative TB results are current, meaning not completed more than 6-months prior to employment. Three (3) of three (3) resident files reviewed contained all the required documentation per regulation.

Administrator states they coordinate residents' medical and dental appointments and transportation to and from visits. Medications and P&I were reviewed and observed managed and maintained within regulation.

No deficiencies were cited during inspection.

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

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC809 (FAS) - (06/04)
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