286803618-5-19-2023-21-AS-CFES-CRYTAL-20230519143344

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 286803618
Report Date: 05/19/2023
Date Signed: 05/19/2023 02:33:50 PM

Document Has Been Signed on 05/19/2023 02:33 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 ACADEMY		FACILITY NUMBER:	286803618
ADMINISTRATOR:	KONAN, MAXIME		FACILITY TYPE:	775
ADDRESS:	3419 BROADWAY STREET H 4-5-6		TELEPHONE:	(510) 692-1804
CITY:	AMERICAN CANYON	STATE: CA	ZIP CODE:	94503
CAPACITY: 45		CENSUS: 15	DATE:	05/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Program Director, Brittanni Murphy		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At approximately 9:45AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required 1 Year visit and met with Program Director, Brittanni Murphy. The facility is an Adult Day Program for adults with physical and intellectual disabilities. The facility has an approved fire clearance for 40 Ambulatory Clients and 5 Non-Ambulatory Clients for a total capacity of 45 individuals. Upon arrival, LPA was informed that there were currently 15 clients attending the program and 8 staff members on-site. At approximately 10:00AM, LPA reviewed the staff roster with Program Director. During review, LPA discovered that Staff Member 1 (S1) was not associated to the facility per regulation. LPA contacted the Regional Office and confirmed the association status of S1 to the facility. Facility confirmed that S1 was not associated to the facility and sent the association paperwork to the Regional Office today, 05/19/2023. LPA confirmed with the Regional Office that the paperwork had been received. At approximately 10:40AM, LPA conducted a walk through of the facility with the Assistant Program Director, Jessica Santillian. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has one large activity/instruction space, a dining space, relaxation rooms, three bathrooms, and office spaces. Facility has three fire extinguishers which were last inspected March 2023. Facility has a hard wired fire alarm and sprinkler system that is directly connected to the local Fire Department. LPA observed that there are no carbon monoxide detectors on site at the program. LPA and Program Director discussed purchasing one detector to have at the program to maintain compliance (See Technical Advisory Note LIC9102 for Health and Safety Code 1503.2)).Program Director to send a picture and receipt as proof of purchase to Community Care Licensing (CCL). Continued on LIC809C

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

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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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: A BRIGHT FUTURE ACADEMY	FACILITY NUMBER: 286803618
	VISIT DATE: 05/19/2023

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Continued from LIC809
Hot water temperatures for 2 of 4 sinks in the facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Two bathrooms designated for Client use were found to be below Title 22 regulations (See Technical Advisory Note LIC9102 for Regulation 82088(e)(1)).Per conversation with Assistant Program Director and Program Director, the two bathrooms have been observed to need maintenance frequently. All temperatures have been logged each month and maintenance visits have been documented. Facility to continue to monitor temperatures to ensure compliance.

Per conversation with Program Director, LPA was informed of the following: P&I Monies are not handled by the facility program. All clients handle their own monetary funds. The facility does not assist with administering medications. The facility does provide some hygiene and assistance with activities of daily living.
At approximately 11:15AM, LPA conducted a sample review of 3 client files and 5 staff files. Client and Staff files were all found to be well organized, thorough and contained the required documentation. Staff files were all found to have First Aid and CPR certification. At approximately 12:45PM, LPA conducted interviews.

**Program Director understands that a civil penalty is not being issued today for S1 because their association paperwork has been received today, 05/19/2023, by the Regional Office to be processed.**

LPA requested the following documents to update the facility file:

Control of Property
Designation of Facility Responsibility (LIC 308)
Emergency Disaster Plan (LIC 610D)
Updated Personnel Report (LIC 500)
Register of Clients/Residents (LIC 9020)
Updated Liability Insurance

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report, Confidential Names (LIC811), LIC9102 (Technical Advisory Notes), discussed and provided to Administrator. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC809 (FAS) - (06/04)

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