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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700498
Report Date: 08/02/2024
Date Signed: 08/06/2024 10:48:55 AM

Document Has Been Signed on 08/06/2024 10:48 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:BRIGHT FUTURES 3FACILITY NUMBER:
392700498
ADMINISTRATOR/
DIRECTOR:
FERLANDO JACKSONFACILITY TYPE:
735
ADDRESS:14151 N TULLY RDTELEPHONE:
(209) 727-5350
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 5CENSUS: 4DATE:
08/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Pamela McgrewTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 08/06/2024 at 9:25 AM, Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection. LPA Martinez met with Pamela Mcgrew and explained the purpose of the visit.

LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Administrator holds current certificate and expires on 01/27/2025. The facility is licensed for five ambulatory clients. There are currently 4 clients who reside at this facility.

The LPA Martinez toured the facility with Pamela Mcgrew on 08/06/2024 at 10:15 AM

LPA Martinez reviewed facility files with Pamela Mcgrew during today's visit. LPA Martinez reviewed 4 client files and 7 staff files, which were maintained. LPA Martinez reviewed 1 medication administration record (MAR), and the MAR was completed. The facility has an infection control plan and a natural disaster plan. The last fire drill was on fire drill 08/02/2024. The fire extinguisher, carbon detectors, and smoke detectors were in good repair. The facility common areas were sanitary and furnished. Client bedrooms and bathrooms were furnished and sanitary. The facility water temperature measured at 105 degrees, and the facility temperature measured at 73 degrees. The facility has an adequate food supply.

Based on this annual inspection there were no deficiencies. An exit interview was conducted, and a copy of this report was given to the facility at the end of the visit.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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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