<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803971
Report Date: 08/26/2021
Date Signed: 09/01/2021 08:22:38 AM

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 LIFE CARE HOME IIFACILITY NUMBER:
486803971
ADMINISTRATOR:SILVERO, PRINCESS DIANAFACILITY TYPE:
740
ADDRESS:1043 SPARROW LANETELEPHONE:
(707) 386-3888
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:6CENSUS: 3DATE:
08/26/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Administrator Princess Diana SilverioTIME COMPLETED:
06:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Karina Canela and Karen Lopez conducted an unannounced post-licensing inspection on 08/26/2021. LPAs met with Administrator Princess Diana Silverio. LPAs observed 3 residents in care. LPAs discussed Emergency Disaster Drills to be conducted every 3 months.
During today’s visit LPAs observed the following items:
· COVID-19 postings and screening station at entrance. LPA's were screened prior to entering.
· Lockable separate cabinets for toxin and knives.
· All exits were unobstructed
· 12 hardwired combination smoke and carbon monoxide detectors, which were tested and observed to be operational
· First Aid kit, night-lights, and flashlights for emergency lighting
· Supply of linens, paper products, and hygiene supplies available
· Grab bars and non-slip mats in 2 of 2 bathrooms.
· Fire Extinguisher charged
· Required furnishings in all 6 resident bedrooms
· A shed in the backyard used for storage
· Administrator Certification (expires 09/11/2021); Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, Emergency Disaster Plan, Client personal rights and visitor policy).
· Water temperature was tested and within regulation of 105 to 120 degrees F
· Auditory devices observed operational
· Resident's medication was centrally stored and locked.
· Food supplies were within regulation
· Facility records were reviewed for residents and staff. Staff have CPR and 1st Aid certifications.

No deficiencies cited during today's inspection
Exit interview conducted with Administrator, Princess Diana Silverio, whose signature below confirms receipt.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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 1