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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701294
Report Date: 09/24/2024
Date Signed: 09/24/2024 11:25:58 AM

Document Has Been Signed on 09/24/2024 11:25 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 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:
09/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:28 AM
MET WITH:Staff on duty (S1)TIME VISIT/
INSPECTION COMPLETED:
11:45 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 9/24/24, at 9:28am, Licensing Program Analyst (LPA) Arvin Villanueva arrived to this facility unannounced to conduct their required annual inspection. LPA initially met with staff on duty (S1 and S2) and stated the purpose of the visit. The Administrator/Co-Licensee Roberto Gellegani (ADM) and Co-Licensee Elizabeth Miranda were notified of this visit and arrived shortly after. Present during today's visit were 2 clients in care with 4 staff.

LPA and S1 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 outdoor furniture for clients' use. Fences, gates and window screens were observed to be in good repair.

Four client bedrooms were inspected and observed to be clean and large enough space to accommodate client belongings. Facility has 2 bathrooms for client use and observed to be clean and in good repair. The kitchen and pantry were inspected and observed to be sanitized and in good repair. Food supplies were stored properly. Facility maintains an adequate amount of food supply with 2-day perishables and 7-day nonperishables. Smoke detectors/carbon monoxide monitor combo were observed and were found to be operable during this visit.

Sharps, toxins and medications were observed to be locked and inaccessible to clients in care. However, LPA observed laundry detergent inside the living room closet that cannot be locked which makes it accessible to clients in care. Also observed that the laundry detergent was next to a bag of rice. S1 immediately corrected the deficiency and placed the laundry detergent under the kitchen sink storage which was observed to be locked.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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 3
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: 09/24/2024
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
26
27
28
29
30
31
32
Facility was observed to have adequate supply of linens for clients. Fire extinguisher was observed at the dining area last serviced on 6/20/24. Room temperature was at 72*F and hot water temperature was at 108*F in the hallway bathroom. Fireplace was observed to be inaccessible to clients and cased in glass.

LPA reviewed 2 of 2 client records and found to be in compliance at this time. LPA reviewed 4 personnel records and were found to be in compliance at this time with current 1st Aid/CPR certificates, ProAct certificates, and background clearances. Facility conducts monthly emergency drills with last drill was conducted on 9/3/24. No changes to the facility sketch were observed.

Copy of the following documents were obtained during their post licensing visit on 8/20/24: current Liability Insurance Certificate, Surety Bond, LIC500, LIC308.

Based on today's inspection, per the California Code of Regulations, Title 22, Division 6, Chapter 6, deficiencies were observed or cited and noted on LIC 809D. Note that failure to correct any deficiencies will result in additional civil penalties.

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

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/24/2024 11:25 AM - It Cannot Be Edited


Created By: Arvin Villanueva On 09/24/2024 at 11:06 AM
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: 09/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80076(a)(16)
Food Service
(a) In facilities providing meals to clients, the following shall apply: (16) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above. During physical inspection, LPA observed a laundry detergent inside the living room closet, next to a bag of rice, that does not lock which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2024
Plan of Correction
1
2
3
4
Staff on duty immediately placed the laundry detergent in a locked cabinet under the kitchen sink.
Per discussion with the Administrator, they will ensure to lock all cleaning supplies not accessible to clients in care.
Per discussion with the Administator, a statement of understading regarding the regulation cited above will be submitted to the Department by the POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3