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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700123
Report Date: 12/10/2021
Date Signed: 12/10/2021 02:54:05 PM

Document Has Been Signed on 12/10/2021 02:54 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:BRIGHT FUTURES IFACILITY NUMBER:
392700123
ADMINISTRATOR:GINA HERNANDEZFACILITY TYPE:
735
ADDRESS:2602 BREAKER WAYTELEPHONE:
(209) 227-5983
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 5CENSUS: 3DATE:
12/10/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Nora Soliasia, Care stqffTIME COMPLETED:
03:15 PM
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
LPA Bruce Jacobs received an incident report from the facility and conducted a follow-up/investigation at the facility on this date. LPA met with caregiver Nora Soliaisia and spoke to Facility Administrator Gina Hernandez by phone. LPA had previously spoken wit D. Bonnett of the facility as well to obtained additional details on the incident report.

Licensing received a report of an interaction between two clients with the initial report indicating one client (C-1) was the initiator. During a follow-up review of the incident by LPA, information was obtained that the client was contacted by Law Enforcement and then taken for evaluation not released back to the facility. It was reported that there were two staff in the home with three clients at the time or the incident

LPA interviewed the staff involved in the incident who provided additional information. Records were reviewed and documents obtained. LPA inspected the bedrooms. Interview conducted with care staff.

At this time there has not been a determination that a deficiency occurred or was identified. A further re3view of the incident will be conducted. No deficiency was issued at the time of this visit.

Exit interview conducted and report issued.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2021
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