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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803940
Report Date: 01/16/2025
Date Signed: 01/16/2025 03:28:20 PM

Document Has Been Signed on 01/16/2025 03:28 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BRIGHT YEARS CARE HOMEFACILITY NUMBER:
486803940
ADMINISTRATOR/
DIRECTOR:		GARCIA, GIORJEOUSFACILITY TYPE:
735
ADDRESS:1223 ETON CTTELEPHONE:
(707) 386-3888
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 4CENSUS: 4DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Giorjeous Garcia, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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At approximately 9:45 AM, Licensing Program Analysts (LPAs) Julie Florio and Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and were greeted by Staff 1 (S1) and Staff 2 (S2). Giorjeous Garcia, Administrator was contacted and arrived at approximately 10:30 AM. Facility is an Adult Residential Facility (ARF) with four clients in care. Client 1 (C1) and Client 2 (C2) were present during today's visit. LPAs were informed that Client 3 (C3) and Client 4 (C4) were away at Day Program. Facility is vendorized with North Bay Regional Center (NBRC).

At approximately 10:30 AM, LPAs initiated a tour of the facility with Administrator and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of clean linens and hygiene, paper, and incontinent care products available for clients. Clients' bedrooms were inspected and observed to have all of the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. Facility has a couple games available for clients, but LPAs did not observe the two clients in care engaged in any during today's inspection, (see LIC809D). Additionally, LPAs witnessed C1, who is unable to leave the facility without assistance, attempt to walk out of the facility front door at least three times during today's inspection. LPAs advised Administrator to increase the facility's game and activity selection for clients in care. Facility has an internet access devise and internet available to clients in care, and the phone was tested an operational during today's inspection.

Facility's fire extinguisher was observed charged and was last serviced 8/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection.

Continued on LIC809C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BRIGHT YEARS CARE HOME
FACILITY NUMBER: 486803940
VISIT DATE: 01/16/2025
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Continued from LIC809...

Facility conducts monthly disaster drills, and the most recent drill was conducted 1/2025. LPAs observed facility's infection control plan and emergency disaster plan which was last updated 1/2024. LPAs observed a supply of PPE, emergency supplies, a first aid kit, flashlights, and a backup battery generator for emergency preparedness.

At approximately 11:00 AM, LPAs reviewed four (4) staff files and four (4) client files. Four (4) of four (4) staff files reviewed have all the required paperwork and proof of current First Aid and CPR training. Four (4) of four (4) client files reviewed have all the required paperwork. Facility has a mobile dentist come to treat the clients and staff coordinate medical visits for the clients and take them to their appointments.

At approximately 1:30 PM, LPAs reviewed medications and medication records which are maintained and stored in compliance with regulation. LPAs reviewed P&I monies and logs, which were organized and maintained and stored in accordance with regulation. However, LPAs observed facility carrying more cash than stated on their LIC400 Affidavit regarding client cash resources and more than they are bonded to carry. LPAs advised Administrator to obtain an additional Surety bond to bring the facility into compliance with regulation and Administrator agreed.

Updated copies of the following documents are to be submitted to CCL within 30 days of this visit:

LIC500 - Personnel Report (updated)
LIC400 - Affidavit Regarding Client Cash Resources
LIC402 - Surety Bond (increased)
LIC610D - Emergency Disaster (updated)

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12 month period, may result in a civil penalty assessment. Appeal rights were provided.

Exit interview conducted with Administrator, whose signature on form confirms receipt.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Julie Florio
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/16/2025 03:28 PM - It Cannot Be Edited


Created By: Julie Florio On 01/16/2025 at 03:03 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: BRIGHT YEARS CARE HOME
FACILITY NUMBER: 486803940

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type B
Section Cited
CCR
85078(a)(1)
Responsibility for Providing Care and Supervision
(1) The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in ensuring the facility engages in daily activities with C1 that align with C1's care plan which poses a potential personal rights risk to C1.
POC Due Date: 02/17/2025
Plan of Correction
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Administrator agrees to submit an activity schedule for C1 which aligns with C1's care plan and to submit an update on the status of C1 being admitted to a new day program to CCL by POC due date 02/17/2025. Additionally, Administrator agrees to submit a sign off sheet where staff confirm each activity was carried out to CCL by POC due date 2/17/2025.
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:Bethany Moellers
LICENSING EVALUATOR NAME:Julie Florio
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2025


LIC809 (FAS) - (06/04)
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