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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701162
Report Date: 09/26/2023
Date Signed: 09/26/2023 03:28:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2023 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230828130206
FACILITY NAME:BRIGHT HOMESFACILITY NUMBER:
342701162
ADMINISTRATOR:SINGH, NIMEESHAFACILITY TYPE:
740
ADDRESS:7976 QUAKER RIDGE WAYTELEPHONE:
(916) 661-9618
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 6DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Nimeesha SinghTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff spoke inappropriately to residents in care.
Staff did not provide proper assistance to resident in care.
Staff did not provide proper food service to resident in care.
Staff did not allow resident's hospice care staff into the facility.
INVESTIGATION FINDINGS:
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On 09/26/2023 at 3:00 PM, Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced to deliver complaint findings. LPA Martinez met with Nimeesha Singh during today’s visit and explained the purpose of today’s visit.

Throughout the course of this investigation, LPA Martinez reviewed facility files, inspected the food supply, and conducted interviews. LPA Martinez interviewed two residents and both residents reported they do not have any concerns about the care staff. The two residents also reported they receive good care. Moreover, LPA interviewed staff 1 (S1) and staff (2). Both staff reported they never witnessed staff 3 (S3) act inappropriate towards residents in care. Moreover, LPA Martinez conducted food inspections on September 05, 2023 and September 20, 2023. LPA Martinez observed that facility had nutritious food. On September 20, 2023, the facility served pancakes with sausage and scrambled eggs and fruits for breakfast, and a hamburger with fries and mandarins and vanilla pudding for lunch.
Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2023 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230828130206

FACILITY NAME:BRIGHT HOMESFACILITY NUMBER:
342701162
ADMINISTRATOR:SINGH, NIMEESHAFACILITY TYPE:
740
ADDRESS:7976 QUAKER RIDGE WAYTELEPHONE:
(916) 661-9618
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:6CENSUS: 6DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH: Nimeesha SinghTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did no provide a copy of the admission agreement to resident's authorized representative.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 09/26/2023 at 3:00 PM to deliver complaint findings, LPA met with Nimeesha Singh, and explained the purpose of the visit.

Throughout the course of the investigation, LPA Martinez conducted interviews and reviewed facility files. It was learned the facility did not provide resident 1's (R1) authorized representative a copy of the signed admission agreement in a timely manner due to the facility printer being out of service. As a result, the facility did not follow Title 22 Regulation, as the licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative, if any, immediately upon signing the admission agreement or modification.

Continued...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20230828130206
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: BRIGHT HOMES
FACILITY NUMBER: 342701162
VISIT DATE: 09/26/2023
NARRATIVE
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As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations.

An exit interview was conducted, and a copy of the 9099 report, LIC 9099-D, and appeal rights were given to the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20230828130206
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: BRIGHT HOMES
FACILITY NUMBER: 342701162
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2023
Section Cited
CCR
87507(e)
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87507(e) Admission Agreement: The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative, if any, immediately upon signing the admission
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The Licensee agrees to conduct an in-service training on admission agreements By POC Date 10/10/2023 by 5 PM. The Licensee agrees to email in-service documents to LPA Martinez by 10/10/2023 by 5 PM.
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agreement or modification... This requirement was not met as evidence by: based on interviews and file review, the Licensee did not ensure to provide R1's authorized representative a copy of the admission agreement upon signing. this posed a potential health and safety risk to R1.
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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: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20230828130206
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: BRIGHT HOMES
FACILITY NUMBER: 342701162
VISIT DATE: 09/26/2023
NARRATIVE
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Additionally, throughout the investigation it was reported the facility offers food substitutions if residents do not want to eat what is scheduled on the menu. On one occasion, it was reported resident 1 (R1) did not want to eat a meal that was being served. S2 and S3 reported R1 requested to eat tomato soup and toast due being sick. It was determined there was not enough evidence to prove the facility is serving non-nutritious meals. Furthermore, S1, S2, and S3 all reported they have never denied hospice staff entry to the facility. As a result, there was not enough evidence to prove facility staff denied entry to hospice staff.

Due to the above noted information, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5