<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
486804006
Report Date:
11/09/2022
Date Signed:
11/09/2022 12:07:10 PM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
11/09/2022 12:07 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
CCLD Regional Office
,
1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA
,
CA
95405
FACILITY NAME:
BRIGHT FUTURE CARE HOME
FACILITY NUMBER:
486804006
ADMINISTRATOR:
REYES, JOHN FRANCOIS DELOS
FACILITY TYPE:
740
ADDRESS:
830 DAFFODIL DR.
TELEPHONE:
(707) 386-3888
CITY:
VACAVILLE
STATE:
CA
ZIP CODE:
95687
CAPACITY:
4
CENSUS:
DATE:
11/09/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:05 PM
MET WITH:
TIME COMPLETED:
12:06 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
Please see prior Required - 1 Year inspection completed on 9/12/2022.
SUPERVISORS NAME
:
Carla Martinez
LICENSING EVALUATOR NAME
:
Kimberley Mota
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/09/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/09/2022
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
1