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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
079200070
Report Date:
06/09/2023
Date Signed:
06/09/2023 05:47:33 PM
Document Has Been Signed on
06/09/2023 05:47 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
E BAY DELTA AC/SC
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
BRIDGE PROGRAM - PLEASANT HILL
FACILITY NUMBER:
079200070
ADMINISTRATOR:
TRAVIS CURRAN
FACILITY TYPE:
735
ADDRESS:
550 PATTERSON BLVD.
TELEPHONE:
(925) 938-8050
CITY:
PLEASANT HILL
STATE:
CA
ZIP CODE:
94523
CAPACITY:
64
CENSUS:
61
DATE:
06/09/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:32 AM
MET WITH:
Kenneth Bullock, Program Director
TIME COMPLETED:
06:00 PM
NARRATIVE
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On 06/09/2023 at 10:32 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Program Director, Kenneth Bullock and explained the purpose of the visit. Nicole Paiste, Campus Administrator, arrived approx. 3:30 PM. The facility’s fire clearance was approved for 64.
LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 32 total bedrooms which 32 bedrooms are occupied by the clients. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable 74 temperature for clients adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 102.7 and 105.3 degree Fahrenheit. All toilets, hand washing and bathing are safe, sanitary and in operating condition. The supply of extra hygienes were available for clients. There is a minimum of one week supply of non-perishable and 2-day perishables food supply.
Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 05/02/2023. Emergency Disaster Drill was last posted on 05/10/2023. First aid kit was observed to be complete. Fire drill was last conducted on 05/10/2023.
At 11:15 AM, 3 of 61 clients records were reviewed. At 12:15 PM, 6 staff records were reviewed and 6 of 6 have current first aid training and associated to the facility.
LIC 809-C continued....
SUPERVISORS NAME
:
Bennett Fong
LICENSING EVALUATOR NAME
:
Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/09/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/09/2023
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
8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
BRIDGE PROGRAM - PLEASANT HILL
FACILITY NUMBER:
079200070
VISIT DATE:
06/09/2023
NARRATIVE
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The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties.
At 10:42 AM, LPA observed mold on the shower walls
At 10:43 AM, LPA observed water temp. in shared bathroom to be 102.7
At 11:07 AM, LPA observed knives in kitchenette area
At 11:15 AM, LPA observed during client record review missing Appraisal Needs and Services Plans
Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/16/2023:
LIC 500 Personnel Report
LIC 308 Designation of Administrative Responsibility
LIC 309 Administrative Organization
LIC 400 Affidavit Regarding Client/Resident Cash Resources
LIC 402 Surety Bond
LIC 610E Emergency Disaster Plan (9 Pages)
Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME
:
Bennett Fong
LICENSING EVALUATOR NAME
:
Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/09/2023
LIC809
(FAS) - (06/04)
Page:
2
of
8
Document Has Been Signed on
06/09/2023 05:47 PM
- It Cannot Be Edited
Created By:
Lori Alexander-Washington
On
06/09/2023
at
05:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
BRIDGE PROGRAM - PLEASANT HILL
FACILITY NUMBER:
079200070
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/09/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)(1)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in by having knives accessible to clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
06/10/2023
Plan of Correction
1
2
3
4
Campus Administrator removed and locked the knives. Deficiency cleared during visit.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
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2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Bennett Fong
LICENSING EVALUATOR NAME:
Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:
DATE:
06/09/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/09/2023
LIC809
(FAS) - (06/04)
Page:
3
of
8
Document Has Been Signed on
06/09/2023 05:47 PM
- It Cannot Be Edited
Created By:
Lori Alexander-Washington
On
06/09/2023
at
05:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
BRIDGE PROGRAM - PLEASANT HILL
FACILITY NUMBER:
079200070
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/09/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in by the mold that is on the shower walls in shared bathrooms which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/23/2023
Plan of Correction
1
2
3
4
Administrator plans to have mold remove. Submit photos to CCLD by POC due date.
Type B
Section Cited
CCR
80088(e)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above by maintaining hot water temp to be 105-120F which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/16/2023
Plan of Correction
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2
3
4
Administrator will adjust the water temp in bathrooms/showers to minimum 105-120F. Submit photos to CCLD displaying the water temp by CCLD POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Bennett Fong
LICENSING EVALUATOR NAME:
Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:
DATE:
06/09/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/09/2023
LIC809
(FAS) - (06/04)
Page:
4
of
8
Document Has Been Signed on
06/09/2023 05:47 PM
- It Cannot Be Edited
Created By:
Lori Alexander-Washington
On
06/09/2023
at
05:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
BRIDGE PROGRAM - PLEASANT HILL
FACILITY NUMBER:
079200070
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/09/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above by maintaining the hot water temp which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/16/2023
Plan of Correction
1
2
3
4
Administrator will adjust hot water temp to minimum 105-120F and submit photos to CCLD by POC due date.
Type B
Section Cited
CCR
85068.2(b)(1)
Needs and Services Plan
(b) If the client is to be admitted, then prior to admission, the licensee shall complete a written Needs and Services Plan, which shall include: (1) The client's desires and background, obtained from the client, the client's family or his/her authorized representative, if any, and licensed professional, where appropriate, regarding the following:
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above by having Needs and Services Plans for clients which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/23/2023
Plan of Correction
1
2
3
4
Administrator will complete Appraisal Needs and Services Plans for clients and submit copies to CCLD by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Bennett Fong
LICENSING EVALUATOR NAME:
Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:
DATE:
06/09/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/09/2023
LIC809
(FAS) - (06/04)
Page:
5
of
8
Document Has Been Signed on
06/09/2023 05:47 PM
- It Cannot Be Edited
Created By:
Lori Alexander-Washington
On
06/09/2023
at
05:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
BRIDGE PROGRAM - PLEASANT HILL
FACILITY NUMBER:
079200070
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/09/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80068.3(a)
Modifications to Needs and Services Plan
(a) The licensee shall ensure that each client's written Needs and Services Plan is updated as often as necessary to assure its accuracy, but at least annually. These modifications shall be maintained in the client's file.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in maintaining Needs and Services Plans for clients which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/23/2023
Plan of Correction
1
2
3
4
Administrator will submit updated copies to CCLD by POC due date.
Type B
Section Cited
CCR
85068.3(a)
Modifications to Needs and Services Plan
(a) The written Needs and Services Plan specified in Section 85068.2 shall be updated as frequently as necessary to ensure its accuracy, and to document significant occurrences that result in changes in the client's physical, mental and/or social functioning.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in maintaining updated Appraisal Needs and Services Plans for clients which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/23/2023
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Bennett Fong
LICENSING EVALUATOR NAME:
Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:
DATE:
06/09/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/09/2023
LIC809
(FAS) - (06/04)
Page:
6
of
8
Document Has Been Signed on
06/09/2023 05:47 PM
- It Cannot Be Edited
Created By:
Lori Alexander-Washington
On
06/09/2023
at
05:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
BRIDGE PROGRAM - PLEASANT HILL
FACILITY NUMBER:
079200070
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/09/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85070(a)(3)
Client Records
(a) In addition to Section 80070, each client record must contain the following information: (3) Needs and Services Plan and any modifications thereto, as specified in Sections 80068.2, 80068.3, 85068.2 and 85068.3.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above by maintaining Needs and Services Plans in client's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/23/2023
Plan of Correction
1
2
3
4
Administrator will submit updated copies of client records to CCLD by POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Bennett Fong
LICENSING EVALUATOR NAME:
Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE:
DATE:
06/09/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/09/2023
LIC809
(FAS) - (06/04)
Page:
7
of
8