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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701294
Report Date: 08/20/2024
Date Signed: 08/20/2024 03:43:31 PM

Document Has Been Signed on 08/20/2024 03:43 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BRIGHTSTAR CAREHOME, INC.FACILITY NUMBER:
342701294
ADMINISTRATOR/
DIRECTOR:		GELLEGANI, ROBERTO M.FACILITY TYPE:
735
ADDRESS:8873 APRICOT WOODS WAYTELEPHONE:
(916) 897-4893
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 2DATE:
08/20/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:23 PM
MET WITH:Roberto GelleganiTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 8/20/24, at 1:20pm, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced at this facility to conduct their post-licensing visit. LPA met with Roberto Gellegani and explained the purpose of the visit. During this visit, there were 1 client in care with 2 staff on duty; 1 client in care was out in the community.

At 1:45pm, LPA and Administrator inspected the physical plant of the facility. The facility is a one-story home located in a residential neighborhood. Front yard and backyard were observed to be clean and free of obstruction. LPA observed a covered patio at the back with outdoor furniture for clients use. The facility does not have bodies of water at this time. Side fence and gate were in good repair. Back fence is in need of repair soon as evidenced by part of the fence is slightly leaning. Per Administrator, they are negotiating with neighbor for the repair. LPA consulted Administrator that is it the Licensee's responsibility for the repair even if neighbor does not want to cooperate.

Four client bedrooms were inspected and observed to be clean and large enough space to accommodate client belongings. Two bathrooms were inspected and observed to be clean and in good repair. The kitchen was inspected and observed to be sanitized and in good repair. During the inspection of the kitchen, LPA observed 2 resident PM medications (bubble packed) inside one of the kitchen cabinet. Administrator immediately placed the medications inside a locked drawer where other medications were kept locked and inaccessible to clients. Food supplies were stored properly. Facility maintains an adequate amount of food supply with 2-day perishables and 7-day nonperishables. Smoke detectors and carbon monoxide monitor were observed and tested and were found to be operable during this visit. Sharps, toxins and medications were observed to be locked and inaccessible to clients. Facility was observed to have adequate supply of linens for clients. Fire extinguisher was observed at the dining area and last serviced on 6/20/24. Room temperature was at 68*F and hot water temperature was at 123*F in one bathrooms. Through interview, the hot water heater was recently replaced on 7/24/24 and still trying to adjust the temperature. Fireplace was observed to be screened. Through interview, fireplace is not being used.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BRIGHTSTAR CAREHOME, INC.
FACILITY NUMBER: 342701294
VISIT DATE: 08/20/2024
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LPA reviewed 2 of 2 client records. LPA observed 1 of 2 client did not have current medical assessment. Per Administrator's statement, client is unable to obtain due to behaviors and will work to try to get medical assessment done as soon as possible. LPA review and counted with Licensee 2 of 2 residents' P&I money and found to be accurate. LPA reviewed 2 of 2 clients medications and found to be in compliance at this time. LPA reviewed 4 personnel records and records were found to be in compliance at this time with current 1st Aid/CPR certificates and background clearance. Facility conducts monthly emergency drills with last drill was conducted on 8/6/24.

LPA requested copies of the following documents to be emailed: current Liability Insurance Certificate, Surety Bond, LIC500, LIC308 and LIC610D.

Based on today's inspection, per the California Code of Regulations, Title 22, Division 6, Chapter 6, deficiencies were observed or cited. Failure to correct deficiencies will subject to civil penalties.

Exit interview held with Roberto Gellagani, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/20/2024 03:43 PM - It Cannot Be Edited


Created By: Arvin Villanueva On 08/20/2024 at 03:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BRIGHTSTAR CAREHOME, INC.
FACILITY NUMBER: 342701294

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Hot water temperature was measured at 123*F during this visit which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/27/2024
Plan of Correction
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Adminsitrator will conduct daily hot water temperature check for 7 days and submit the hot water temperature record to the Department by POC due date.
Type B
Section Cited
CCR
80075(k)(1)
Health-Related Services
(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. During inspection of the kitchen, LPA observed 2 resident PM medications (bubble packed) inside one of the kitchen cabinets which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/27/2024
Plan of Correction
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Administrator will submit a statement of understanding relating to the citation noted above regarding proper medication storage. Statement to be submitted to the Department by POC due date.
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:Stephen Richardson
LICENSING EVALUATOR NAME:Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024


LIC809 (FAS) - (06/04)
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