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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803873
Report Date: 08/04/2021
Date Signed: 08/04/2021 02:37:54 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:BRIGHT PATH CARE HOMEFACILITY NUMBER:
486803873
ADMINISTRATOR:SILVERIO, ARNELFACILITY TYPE:
740
ADDRESS:2170 HAUSAM LANETELEPHONE:
(707) 386-3888
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 6DATE:
08/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Arnel Silverio, AdministratorTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required inspection and met with Arnel Silverio, Licensee and Administrator. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly.

LPA conducted a walk-through of the facility with staff and observed COVID-19 precaution postings. LPA observed a screening station at front entrance of facility which had a hand sanitizer, a thermometer, and a sign-in sheet for visitors and staff. Visitors and staff are screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. Client's temperatures are taken twice a day and LPA observed documentation. Staff clean and disinfect the facility twice daily. High touched surface areas are disinfected after each use. The facility has a designated visitation area, provides virtual visits and phone calls for family/visitors to stay in contact with clients.
LPA observed 6 clients in care. Staff have completed training on infection prevention, symptoms, transmission and PPE use. N-95 respirator Fit testing (Cal/OSHA requirement) was completed. The facility has a supply of PPE including gloves, face shields/goggles, N-95 respirators, surgical masks and disposable gowns.
The facility has submitted a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 which was reviewed by the California Department of Social Services.

Exit interview conducted with Licensee, whose signature on this document confirms receipt.

No deficiencies cited during this inspection
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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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