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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803618
Report Date: 05/17/2024
Date Signed: 05/17/2024 12:25:55 PM

Document Has Been Signed on 05/17/2024 12:25 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/
DIRECTOR:		KONAN, MAXIMEFACILITY TYPE:
775
ADDRESS:3419 BROADWAY STREET H 4-5-6TELEPHONE:
(510) 692-1804
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY: 45CENSUS: 12DATE:
05/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Alex HernandezTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
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At approximately 9:00AM, Licensing Program Analyst's (LPA's) Jacky Macias and Chris Arnhold arrived unannounced at this Licensed Day Program to conduct an Annual Required Inspection. LPA's met with Program Director Alex Hernandez and toured the facility. This Day Program operates Monday -Friday. There were 12 Clients and 9 Staff present at the time of this inspection. LPA's observed 1 staff working that does not have a cleared background clearance, one staff is not associated to the facility and a third staff who was working at the facility for three days without a clearance. An immediate civil penalty in the amount of $1,300 is being issued. The facility consists of offices, a large activity room, several smaller rooms, a kitchenette, and three bathrooms. LPA's observed the facility was a comfortable temperature and found all exits and walkways to be unobstructed. The facility grounds were also kept clean and without hazards. Clients bring lunches. Snacks are available for clients. There is a cooking class offered to clients several times a month.
Toxins are centrally stored in a locked closet of the facility. Water temperature at 3 of 3 bathrooms measured within regulation between 105 and 120 degrees at faucets accessible to clients. Client money is not handled by facility. Day Program staff store client medication if Clients are taking medication. Clients do crafts and games while at program. At approximately 10:45AM, LPA's reviewed 10 of 12 client files and found files to be thorough and contain current client care assessments and individualized Service Plans. Staff records were also found to be current, including staff first aid and CPR training verification. Disaster drills are conducted monthly.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.


This report was reviewed with Alex Hernandez and Appeal rights were given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
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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Document Has Been Signed on 05/17/2024 12:25 PM - It Cannot Be Edited


Created By: Christopher Arnhold On 05/17/2024 at 11:54 AM
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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: A BRIGHT FUTURE ACADEMY
FACILITY NUMBER: 286803618

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type A
Section Cited
HSC
1522(c)(1)
General Provisions
(c)(1) Subsequent to initial licensure, a person specified in subdivision (b) who is not exempted from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification pursuant to subdivision (g) of this section or Section 1522.7 from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Observation and records reviewed, the licensee did not comply with the section cited above. Three staff were working in the facility without a background clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/20/2024
Plan of Correction
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Licensee shall ensure all staff receive a background clearance or exemption prior to working with clients. Licensee to submit self certification that all staff have received a clearance or exemption prior to returning to the facility. Self certification shall be submitted to CCL by POC date of 05/20/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Bethany Moellers
LICENSING EVALUATOR NAME:Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/17/2024 12:25 PM - It Cannot Be Edited


Created By: Christopher Arnhold On 05/17/2024 at 11:54 AM
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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: A BRIGHT FUTURE ACADEMY
FACILITY NUMBER: 286803618

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82071(a)
Register of Clients
(a) The licensee shall maintain in the program site a register of all clients. The register shall be updated as needed; shall be immediately available to, and copied for, licensing staff upon request; and must contain current information on the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Facility did not have a Register of Clients, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2024
Plan of Correction
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Licensee shall develop a register of clients and keep it updated. Completed register of clients shall be submitted to CCL by POC date of 05/31/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Bethany Moellers
LICENSING EVALUATOR NAME:Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2024


LIC809 (FAS) - (06/04)
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