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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803618
Report Date: 08/04/2022
Date Signed: 08/04/2022 12:55:31 PM

Document Has Been Signed on 08/04/2022 12:55 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:A BRIGHT FUTURE ACADEMYFACILITY NUMBER:
286803618
ADMINISTRATOR:KONAN, MAXIMEFACILITY TYPE:
775
ADDRESS:3419 BROADWAY STREET H 4-5-6TELEPHONE:
(510) 692-1804
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY: 45CENSUS: 10DATE:
08/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Director, Brittanni MurphyTIME COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 08/04/2022 at approximately 12:20 PM to conduct a case management inspection. Inspection is regarding an incident report received by Community Care Licensing on 07/19/2022. LPA met with Director, Brittanni Murphy

During the inspection LPA reviewed records and conducted interviews.

No deficiencies cited during today's inspection.

Exit interview conducted with director and a copy of this report emailed to the facility.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Erik Gonzalez Campos
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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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