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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803940
Report Date: 04/09/2025
Date Signed: 04/09/2025 02:04:03 PM

Document Has Been Signed on 04/09/2025 02:04 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: DATE:
04/09/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Arnel Silverio, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 4/9/25, at approximately 1:00 PM, an office meeting was conducted in the Santa Rosa Regional Office. Present in the meeting were Licensing Program Manager, Bethany Moellers, Licensing Program Analysts, Julie Florio, Licensees, Arnel Silverio and Wilma Garcia, and Administrator, Giorjeous Garcia. Additionally, North Bay Regional Center (NBRC) service coordinator, Shawna Cleveland, NBRC supervisor, Heather Nore, HCBS consultant, Charles Clariza, and BCBA Belen Sidhu also attended the meeting via Teams video conferencing.

The purpose of the office meeting was to discuss areas of ongoing observed concerns regarding safety, supervision, and engagement in daily activities with Client 1 (C1) that align with C1's care plan. LPA's concerns first arose as the result of observations made, interviews conducted and records, reviewed during the course of investigating complaint #21-AS-20240618114027 which was received by the Department on 06/18/202. During the course of the investigation, it was revealed that C1 became agitated on 06/13/2024, began to yell, jumped up, became physical and punched a facility guest. LPA conducted site visits on 6/27/2025 and 10/31/2025 for this complaint investigation. During the course of these visits, LPA observed C1 not engaged in activities and wandering unattended throughout the facility and out the front door.

On 01/16/2025, during the course of a required 1-year annual inspection visit, LPA observed C1 wandering the facility and out the front door at least three times, resulting in LPA alerting facility staff that C1 had wandered out the front door. Further, LPA observed scheduled activities not actively occurring or being offered as scheduled and facility was unable to produce the materials any such activities would require.

Continued on LIC809C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Julie Florio
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 04/09/2025
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Continued from LIC809...

Additionally, during the course of the annual inspection, LPA was informed that the facility is funded for 1:1 supervision and support for C1 in lieu of day program hours. The Licensee was informed that this office meeting is to address areas of concern including but not limited to the following:

- Supervision and Safety
- Engaging activities which align with C1's care plan
- Day Programs

The outcome of today's office meeting:

- C1 has been accepted into No Barriers, a community based day program - start date is pending.
- NBRC is working with C1's conservator on further diagnoses and possible medication treatment
- NBRC has conducted an activities preference assessment - revealed limited preferred activities by C1
- Park outings have been increased to twice per week for about 25-30 minutes per outing
- Facility has implemented a tracking system to account for attempts to offer engaging activities and the outcome of each.

Exit interview conducted with Licensee whose signature on form confirms receipt of documents.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Julie Florio
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC809 (FAS) - (06/04)
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