<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002922
Report Date: 01/29/2025
Date Signed: 01/29/2025 01:04:00 PM

Document Has Been Signed on 01/29/2025 01:04 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BRILLIANT CARE HOMEFACILITY NUMBER:
315002922
ADMINISTRATOR/
DIRECTOR:		NESBITT, KARLAFACILITY TYPE:
740
ADDRESS:1105 NOB HILL COURTTELEPHONE:
(916) 993-3133
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/29/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Administrator, Karla NesbittTIME VISIT/
INSPECTION COMPLETED:
01:20 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
Licensing Program Manager (LPM)- Laura Munoz, Regional Manager - Alycia Rayner ,Licensing Program Analyst (LPA) -Talwinder Bains arrived on 01/29/25 to conduct the annual inspection. CCL staff met with Administrator, Karla Nesbitt and explained the purpose of today's visit.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. Staff reviewed medications of four (4) residents comparing with physician orders . Staff reviewed four (4) residents files and two (2) staff files and found all required paperwork.

Staff and Administrator toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Hot water temperature was observed to be 112 degrees F, which is within the regulation range of 105-120 degree. Fire extinguisher was last serviced on 06/21/24 and was ready for emergency use.

Citations were observed and issued as listed on LIC809-D per Title 22 ,CCR Regulations from this visit.

LPA requested a copy of the LIC308, LIC 500, LIC610E and current liability insurance to be sent to the Department by 02/10/25.

Civil penalties shall be assessed if facility does not comply with POC requirements which were issued today. Exit interview conducted. Copy of this report and appeal rights were provided.
Laura MunozTELEPHONE: (916) 263-4743
Talwinder BainsTELEPHONE: (916) 263-4700
DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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 3
Document Has Been Signed on 01/29/2025 01:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: BRILLIANT CARE HOME
FACILITY NUMBER: 315002922

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2025
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
LPA observed that facility's staff left cabinet open by the kitchen which has disinfectants, cleaning solutions which were accessible to residents and poses a immediate health and safety risks to residents in care.
POC Due Date: 01/30/2025
Plan of Correction
1
2
3
4
The Licensee will put the Lock on the cleaning supply cabinet , send the letter of understanding of this regulation and will train staff regarding this regulation and will send training documents to CCL. POC due date - 01/30/25.
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.
Laura MunozTELEPHONE: (916) 263-4743
Talwinder BainsTELEPHONE: (916) 263-4700

DATE: 01/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2025

LIC809 (FAS) - (06/04)
Page: 2 of 3