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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701294
Report Date: 10/07/2024
Date Signed: 10/07/2024 03:46:45 PM

Document Has Been Signed on 10/07/2024 03:46 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:
10/07/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:42 PM
MET WITH:Roberto GelleganiTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 10/7/24, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to this facility to conduct a case management visit. LPA met with facility Administrator, Roberto Gellagani (AD), and explained the purpose of the visit. Present during this visit were 2 clients in care with 2 staff on duty. The Regional Office received a Facility Action Report (FAR) dated 09/30/2024 from Alta California Regional Center (ACRC).

ACRC representative conducted an unannounced visit to the facility and identified several deficiencies. According to the FAR, the following issues were noted during the visit: seven staff members lacked proof of current First Aid and/or CPR certification; one staff member had not completed the LIC500 form; one staff member does not have evidence of Continuing Education Units (CEUs) or completion of Direct Support Professional (DSP) Year 1 training; two staff members did not have evidence of Behavior Management Training within the required 30 days of hire; and one staff member lacked proof of On-Site Orientation.

Prior to today's visit, the Administrator has addressed and completed the necessary corrections as stipulated by ACRC.



Based on today's inspection, per the California Code of Regulations, Title 22, Division 6, Chapter 6, deficiencies were observed or cited. Note that deficiencies have been corrected prior to today's visit.

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: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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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Document Has Been Signed on 10/07/2024 03:46 PM - It Cannot Be Edited


Created By: Arvin Villanueva On 10/07/2024 at 03:26 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: 10/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2024
Section Cited
CCR
80075(f)

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(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.

This requirement is not met as evidenced by:
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Deficiencies has been corrected and proof of correction has been submitted to ACRC prior to today's visit.
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Based on record review, the licensee did not comply with the section cited above. It was noted during ACRC visit that 1 staff had an expired 1st Aid/CPR certificate, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
10/14/2024
Section Cited
CCR80066(a)

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80066 Personnel Records: (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.
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Deficiencies has been corrected and proof of correction has been submitted to ACRC prior to today's visit.
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Based on record review, the licensee did not comply with the section cited above. It was noted during ACRC visit that some staff files were lacking proof of 1st Aid CPR, required trainings, and incomplete application, which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Stephen Richardson
LICENSING EVALUATOR NAME:Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2024


LIC809 (FAS) - (06/04)
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