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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486830724
Report Date: 06/23/2021
Date Signed: 06/23/2021 12:03:40 PM

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 HOMEFACILITY NUMBER:
486830724
ADMINISTRATOR:SILVERIO, ARNELFACILITY TYPE:
740
ADDRESS:1736 NEWARK LANETELEPHONE:
(707) 386-3888
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:6CENSUS: 4DATE:
06/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:Arnel SilverioTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Katrina Walters and Jill Nakagawa conducted an unannounced Annual Required – 1 year Infection Control inspection visit to this facility and was greeted by staff. Administrator, Arnel Silverio (6022666740 exp 5/14/2022) arrived later. At the time of inspection there were two staff providing care and supervision for four residents. Three residents were in the living room and one resident was in their bedroom participating in virtual day program activities.

Upon arrival at the facility LPAs had temperature checked and logged at the entrance. All staff were wearing mask. There was one entry point for the facility. Hand sanitizer was available for use. Signs were posted on facility door and throughout the facility to promote hand washing and social distancing. LPAs toured the facility with Administrator. During facility tour the facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Administrator indicated each client could isolate in their own room if needed for COVID-19. Per Administrator all staff have been fit tested and are trained on infection control by Solano County Public Health. Facility has Personal Protective Equipment (PPE) stored in the garage on shelves. Facility has a cleaning and disinfecting schedule that occurs frequently through out the day. Client emergency contact information has been updated and Emergency Personnel numbers are posted at the facility. Clients’ medications are stored in a locked cabinet. Each client has an emergency kit stored in the bedroom. Facility has at least 30-day supply of medication for clients based on pharmacy supply and refill practices. Staff and Residents are screened daily for COVID-19 symptoms and logged into facility binders. The Licensee submitted a mitigation plan that was approved on 3/3/2021.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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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