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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804047
Report Date: 03/04/2022
Date Signed: 03/04/2022 03:45:17 PM


Document Has Been Signed on 03/04/2022 03:45 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 QUEST CARE HOMEFACILITY NUMBER:
486804047
ADMINISTRATOR:AQUINO, RHENZFACILITY TYPE:
740
ADDRESS:1417 PROSPECT WAYTELEPHONE:
(707) 386-3888
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:4CENSUS: 0DATE:
03/04/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administraotr, Rhenz AquinoTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Walters conducted a pre-licensing inspection and met with applicant Arnel Silverio, and Rhenz Aquiono who will be the facility Administrator once the application is approved for licensure. The facility received a fire clearance approval on 1/3/2022 by the Suisun CIty Fire Department for 4 non-ambulatory clients. The facility has an approved Hospice Waiver for 2 residents and a Dementia Care Plan within their Plan of Operation. Facility will operate with live-in staff and Licensee will ensure sufficient staffing at all times.

LPA toured facility and observed: Facility is a single story residence, with a total of 4 client bedrooms, 2 baths, living room, dinning room, kitchen, and laundry room. The facility was observed to be clean, well organized and in good repair. Upon entering the facility, signs were posted to promote social distancing and droplet precaution. The visitor sign is posted at the entrance of the facility, along with hand sanitizer and disposable and N-95 face coverings.

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SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2022
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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: BRIGHT QUEST CARE HOME
FACILITY NUMBER: 486804047
VISIT DATE: 03/04/2022
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All bedrooms were observed to have the required furnishings, such as a bed, night stand, dresser, lamp and a chair. Beds were observed to have the required linens. Hallways were observed with automatic night-lights for the safety of the clients. There is an ample supply of personal hygiene products, extra bedding, towels and linens. The refrigerator was observed to be clean. Facility had a non-perishable food supply as required per regulation. A designated locked cabinet in the kitchen stores knives and sharps. The cabinet under the kitchen sink and in the bathroom cabinet are used to store cleaning supplies, and LPA observed them locked with magnet lock. The facility has a first aid kit with all required items. Personnel and clients records are stored in locked cabinet. LPA observed there are several binders labeled and organized with facility records. There is a locked medication cabinet to keep medications inaccessible to clients.

Smoke detector and carbon monoxide detectors were found to be working at the time of the inspection. LPA observed that the Fire extinguisher was charged and serviced on 3/1/2022. Water temperature was tested by the Administrator and found to be at 116.3, within the required regulation of 105-120 degrees f. LPA toured the yard, and observed it to be clean, with patio furnishings available to clients. Facility postings and the required COVID-19 postings for the facility were observed. Facility has at least a 30 day supply of Personal Protective Equipment. (PPE) Cleaning and Paper Products.

LPA conducted the Component III with Administrator and Licensee. LPA will forward a completed pre-licensing inspection report and notify the Application Unit so application process may proceed. Application Unit Analyst will notify applicant of application status.

Pre-Licensing is complete, and this facility has no deficiencies
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022
LIC809 (FAS) - (06/04)
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