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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700715
Report Date: 02/02/2022
Date Signed: 02/02/2022 12:17:13 PM

Document Has Been Signed on 02/02/2022 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
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: 3DATE:
02/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jean Gonzales, CaregiverTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with Caregiver Jean Gonzales during today's inspection, and informed Administrator Ida Redhair that LPA was completing an annual inspection. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPA was screened by staff upon entering the facility.
Currently there are 3 clients living at the facility. 1 of 3 clients were at program during today's inspection. LPA toured the facility and inspected the interior and the exterior of the facility including the common living spaces, 4 client bedrooms and 2 bathrooms, kitchen and garage. Bathrooms and bedrooms were clean and in good repair. LPA toured the backyard and all exits are accessible and unlocked. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguishers were found to be up to date and charged. LPA observed an adequate amount of linens and PPE supplies.
LPA reviewed 2 of 3 resident records and 2 staff records. LPA reviewed medications of two resident comparing with Centrally Stored Medication Record and physician orders and reviewed 2 of 3 client P&I records. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility.

During today's inspection, no deficiencies have been cited. LPA printed PIN 22-01 and 610D for facility to update their emergency disaster plan.

Exit Interview conducted and appeal rights given.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2022
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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