331880857-12-6-2023-18-AS-CNWE-CY9RT3-20231206121739

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880857
Report Date: 12/06/2023
Date Signed: 12/06/2023 12:17:47 PM

Document Has Been Signed on 12/06/2023 12:17 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	BRIGHTON RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	331880857
ADMINISTRATOR:	TUMALIUAN, MARIA DIANA		FACILITY TYPE:	740
ADDRESS:	39396 BRIGHTON STREET		TELEPHONE:	(951) 696-7712
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY:	6	CENSUS: 5	DATE:	12/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Maria Tumaliuan, Administrator		TIME COMPLETED:	12:25 PM

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On 12/6/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by Caregiver, McKelvin Tumaliuan. LPA also met with Administrator, Mariadiana Tumaliuan who was informed of the purpose of visit. At the time of visit there was 3 staff and 5 residents present. LPA toured the facility inside and out with Mariadiana Tumaliuan.

Tour included:

Kitchen: LPA toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the census. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen cabinet under the sink, available only to authorized individuals. Trash cans has tight-fitting lid. Dishwasher is used to clean and sanitize dishes. Fridge, freezer, and all need appliances were present and shown to be in working condition and clean.

Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 75 degrees Fahrenheit.

Hallway: LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items.

Medication: Medications were labeled and stored in separate bins inside of a locked kitchen cabinet and are distributed according to physician orders. The first aid kit was complete.

Continue on LIC809-C

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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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Document Has Been Signed on 12/06/2023 12:17 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRIGHTON RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 331880857
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(a)

Maintenance and Operation

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above by having resident bedroom #2 ceiling and wall in disrepair since October 2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/15/2023
	Plan of Correction
1 2 3 4	Administrator stated the wall and ceiling will be fixed tomorrow 12/7/2023 and a picture will be provided to LPA by the POC due date 12/15/2023.

Type B

Section Cited

CCR

87412(f)

Personnel Records

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above by not having documentation of staff #1 health screening, and TB test availbale for LPA to review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/15/2023
	Plan of Correction
1 2 3 4	Administrator stated a proof of the staff #1 health screening, and TB test will be provided to LPA by the POC due date 12/15/2023.

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: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRIGHTON RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 331880857
	VISIT DATE: 12/06/2023

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Continued from LIC809.

Bathroom: LPA toured hall bathroom and observed bathroom to be clean and equipped with grab bar and non-skid mat. There is also a good number of personal toiletries available for the residents in care. The hot water measured at 119 degrees Fahrenheit.

Bedroom: LPA toured four #4 out of #4 resident bedrooms and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs, and lighting. Night lights were maintained throughout the facility. Resident #3 bedroom has a private bathroom. LPA observed bathroom to be clean and hot water was measured at 119 degrees Fahrenheit. During LPA’s tour of bedroom #2, LPA observed bedroom #2 wall and ceiling to be open and covered with a plastic wrap. Administrator stated there was a leak in the roof that happened in October. The repairs took longer because of the insurance company and finding a repairer. Administrator stated the leak has been repaired, the wall and ceiling will be repaired tomorrow 12/7/2023. LPA observed resident’s belongings in the bedroom and asked if residents sleep in the room while repair is going on, Administrator responded yes, and stated when the leak happened, residents were moved to other bedrooms but were moved back to their rooms when facility admitted additional residents. Administrator stated that there are no more extra bedrooms and since the leak has been repaired, the facility received an approval from the inspection person that the room is ok and safe for the residents to sleep in. LPA informed Administrator that residents should not sleep in the room during the repairs to avoid inhalation of toxins, Administrator stated ok, understood (citation will be issued).

Garage: LPA tour the garage and observed garage to be clean.

Laundry: Washing machine and dryer are all in good repair and sufficient for census. Cleaning supplies are stored away in the laundry room, inaccessible to clients.

Backyard: LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gate remain unlocked. No bodies of water were observed.

Continue on LIC809-C

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRIGHTON RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 331880857
	VISIT DATE: 12/06/2023

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Continued from LIC809-C.

Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents. Fridge and freezer are large enough to accommodate required perishable foods.

Records: All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. Three #3 staff and #3 residents' records were reviewed. LPA observed one #1 staff has no documentation of health screening, and TB test. Staff stated heath screening and TB test were completed. Administrator stated Licensee has the records but is not available to provide it to LPA at the moment (Citation will be issued).

Interview: Three #3 staff and four #4 residents were interviewed.

Therefore, based on the observations made during today’s visit, two #2 deficiencies will be cited per Title 22, Division 6 of the California Code of Regulations. See LIC809-D. An exit interview was conducted, and this reported was provided along with appeal rights to Mariadiana Tumaliuan.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC809 (FAS) - (06/04)

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