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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700715
Report Date: 01/03/2022
Date Signed: 01/04/2022 10:02:40 AM

Document Has Been Signed on 01/04/2022 10:02 AM - 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:BRIDAN HOME CAREFACILITY NUMBER:
342700715
ADMINISTRATOR:REDHAIR, IDAFACILITY TYPE:
735
ADDRESS:5525 BELLINGHAM WAYTELEPHONE:
(916) 833-1801
CITY:ORANGEVALE,STATE: CAZIP CODE:
95662
CAPACITY: 4CENSUS: 4DATE:
01/03/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Ida Redhair, AdministratorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Bethany Huusfeldt, Talwinder Bains, and Lavinia Muscan and Licensing Program Manager (LPM) Laura Munoz, and Regional Manager Alycia Berryman met with Administrator Ida Redhair, Behavior Specialist Dr. Brister, and Alta Regional staff John Decker, Andy Ponce, Olivia Procida, Deveon, Odelia Harrison Johns, Mechelle Johnson and Johnny Xiong. Today's meeting was conducting over Microsoft Teams meeting to discuss the 3-day eviction request for C1 from facility.

Today's meeting was to address the following issues:
  • 3-day eviction request from facility.
  • C1's current behaviors, concerns, and interventions.
  • Plans to support C1's behaviors going forward.

The Facility agrees to do the following:
  • Incident reports are to be sent into CCL within 7 days of occurrence.
  • A copy of C1's 30 day eviction request to be sent to CCL within 2 business days.
  • Seclusion rooms are not permitted and will not be used in the facility.
  • Licensee agrees to accept C1 back to facility once discharge has been initiated from hospital.
  • Within 30 days, licensee to submit into CCL and Alta regional center an approved behavior plan for C1.

3 day eviction request has been denied. Exit interview conducted. A copy of report was emailed to licensee. Licensee to review, sign, and return a signed copy of report to CCL within 2 business days.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2022
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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