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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700715
Report Date: 01/18/2024
Date Signed: 01/18/2024 12:08:06 PM

Document Has Been Signed on 01/18/2024 12:08 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: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:
01/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Administrator, Ida RedhairTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 01/18/24 to conduct a case management visit regarding an incident report Community Care Licensing (CCL) received on 01/11/24, LPA met with administrator, Ida Redhair and explained the purpose of the visit.

Incident report received on 01/11/24 stated that resident, R1 was found by staff on 01/11/24 at 12 AM that R1s was bleeding from their nose in R1s bedroom. Staff respond when they heard a low little whimper sound from R1's room. Staff saw that R1 was sitting on their bed with a blood on their hand. Staff checked R1s face and saw a little over half­inch cut or tear on his right upper eye brows and some red blood spots from R1s nose. Staff applied first aid to stop the blood. Staff asked R1 what happened. R1 pointed the edge of the side drawer. R1 said they were about to reach their water to drink from the side table but they fell and hit their face on the edge. Staff took R1 to nearest hospital for proper medical attention.
R1 was then seen right away before 1 AM at hospital ER on the same date (1/11/24). Lab tests were conducted and results were fine. Chest x-ray did not show acute cardiopulmonary abnormality. CT head and neck did not show fracture or subluxation or intracranial pathology. Urinalysis did not show any infections. EKG readings were normal. R1 had a minor fracture in their nose and minor laceration on face. R1 was discharged at 4am in morning on 01/11/24.

After record review and interview with staff, it has been concluded that the facility took appropriate measures to address R1s health condition on 01/11/24 and take them to hospital to seek medical care in timely way. Per staff, R1 was at their baseline and were at day program during today's visit. Facility will implement cushion padding on R1s side drawer to prevent any future injuries.

There are no deficiencies being cited as a result of todays visit.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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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