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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700715
Report Date: 09/05/2024
Date Signed: 09/05/2024 11:17:27 AM

Document Has Been Signed on 09/05/2024 11:17 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BRIDAN HOME CAREFACILITY NUMBER:
342700715
ADMINISTRATOR/
DIRECTOR:		REDHAIR, IDAFACILITY TYPE:
735
ADDRESS:5525 BELLINGHAM WAYTELEPHONE:
(916) 833-1801
CITY:ORANGEVALE,STATE: CAZIP CODE:
95662
CAPACITY: 4CENSUS: 3DATE:
09/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Staff, Jean GonzalesTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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
On 09/05/2024, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility to conduct case management visit follow up regarding an incident that occurred on 08/31/2024 as facility reported on 9/1/2024. LPA met with staff, Jean Gonzales and explained the purpose of the visit.

The visit was in response to a report from the facility regarding an incident that occurred on 08/31/24. According to the report, on 08/31/2024, at around 9:45 PM, resident, R1 was leaving the facility with staff for a shopping trip when R1 experienced a change in condition. The facility contacted local law enforcement and emergency services, but R1 passed away at approximately 10:20 PM. The facility notified all relevant parties involved regarding R1 passing.

During the visit, LPA Bains conducted a reviewed R1s file and interviewed three staff members and three residents. LPA is requesting relevant documents related to the incident. All these requested documents shall by submitted via email to LPA Bains by 09/08/24.

At this time, this incident is under review and department will do follow up if warranted.
Exit interview conducted and copy of the report left at facility.


SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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 1