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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804047
Report Date: 03/23/2023
Date Signed: 03/23/2023 12:36:21 PM


Document Has Been Signed on 03/23/2023 12:36 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: 4DATE:
03/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Arnel SilverioTIME COMPLETED:
12:45 PM
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At approximately 8:45AM, Licensing Program Analyst's (LPA's) Jill Nakagawa and Chris Arnhold made an unannounced annual required inspection of this licensed senior care facility. LPA's met with Administrator Arnel Silverio. At approximately 9:00AM, LPA's toured the building and grounds which was found to be clean and in good repair. LPA's observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA's observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked storage closet. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were charged. Smoke detectors were found to be in working order. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure.

At approximately 9:45AM, LPA's reviewed 4 of 4 resident records. 4 of 4 records contained current and signed admission agreements and physician's orders were on file. Medication records are thorough and contained physician's orders for each resident.

At approximately 11:05AM, LPA's reviewed 3 staff records. Evidence of current first aid and CPR training were current. 3 of 3 records contained the required documentation.

Continued on LIC809-C...
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
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: 03/23/2023
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At approximately 11:45AM, LPA's reviewed the facility emergency disaster plan with staff. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 03/13/2023.

Updated copy of the following document was requested for facility file and is to be submitted to CCL within 30 days of this visit:

Evidence of Liability Insurance

No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC809 (FAS) - (06/04)
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