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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803242
Report Date: 01/07/2022
Date Signed: 01/07/2022 04:09:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:BRIGHTON CARE HOMEFACILITY NUMBER:
486803242
ADMINISTRATOR:SADDI, EILEENFACILITY TYPE:
740
ADDRESS:196 BRIGHTON CIRCLETELEPHONE:
(707) 451-7288
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:6CENSUS: 3DATE:
01/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:44 PM
MET WITH:Eilleen SaddiTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Walters arrived unannounced to conduct a REQUIRED 1 Year Annual Inspection. LPA was greeted by staff. Administrator, Eileen Saddi arrived later. This visit is focused on the infection control. The facility submitted an infection control mitigation plan to Community Care Licensing, which was approved on 03/10/21. At the time of inspection, there were three clients in care.

At the entrance of the facility, there is sign in sheet for visitors, hand sanitizer, disposable mask and signs were posted to promote social distancing and cough etiquette. LPA discussed ensuring that staff sign in all visitors to the facility. Additional Personal Protective Equipment and Incontinence products are stored in the garage. Medication was centrally stored and locked in a hallway closet.

Signs were posted in the facility bathrooms to promote hand washing, however there was no paper towels in either bathroom. LPA and Administrator discussed using paper towel instead of cloth and increasing the amount of hand washing supplies for infection control.
LPA Walters and Administrator also discussed keeping a log of all residents to monitor for temperatures and symptoms. In addition, facility staff to document, completed training on PPE use, isolation policies, and infection prevention. N-95 respirator Fit testing (Cal/OSHA requirement) is in process. The carbon monoxide and smoke detectors were tested and they appeared to be in working order. 1 of 1 Fire extinguisher was last serviced on 02/19/2019. LPA is requesting that Administrator sends a the following to Community Care Licensing by 1/11/21 attention LPA Walters: Updated copy of LIC 500, Liability insurance, Updated LIC 308, and proof that the Administrator has ordered a fire inspection, a log of residents temperatures and symptoms from 1/7/21-1/11/21.

Continued on to LIC 809 C
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
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
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: BRIGHTON CARE HOME
FACILITY NUMBER: 486803242
VISIT DATE: 01/07/2022
NARRATIVE
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Continued from 809

Appeal Rights Provided.
Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiencies and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Licensee Eileen Saddi whose signature below confirms receipt of this report.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: BRIGHTON CARE HOME
FACILITY NUMBER: 486803242
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87203
87203 Fire Safety - All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

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 in 1 out of 1 fire extinguisher was charged but not serviced which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/14/2022
Plan of Correction
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Licensee to have 1 of 1 fire extinguishers serviced. Licensee to submit Proof of Correction (POC) that fire extinguishers have been serviced and charged by a fire extinguisher service company or the Fire Department. POC due date 01/14/2021
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3