486830724-10-3-2023-21-AS-BMOS-CWQVDC-20231018162032

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486830724
Report Date: 10/03/2023
Date Signed: 10/03/2023 10:33:02 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230725124319

FACILITY NAME:	BRIGHT LIFE CARE HOME		FACILITY NUMBER:	486830724
ADMINISTRATOR:	VERGELLIO SILVERIO		FACILITY TYPE:	740
ADDRESS:	1736 NEWARK LANE		TELEPHONE:	(707) 386-3888
CITY:	SUISUN CITY	STATE: CA	ZIP CODE:	94585
CAPACITY:	6	CENSUS: 4	DATE:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Marivic Dela Cruz		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff are not according dignity to resident in care.
Staff member is phycially abusing resident in care.
Staff are interferring with resident's toileting needs while in care.

INVESTIGATION FINDINGS:

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At approximately 9:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with caregiver Marivic Dela Cruz, interviewed clients and reviewed records. Based on interviews conducted and records reviewed, C1 has a long history of making false accusations against others. This behavior is documented in their individual behavior support plans for the home and day program. C1 has a behavior consultant that has been working with the facility to address these behaviors. LPA was informed that Law Enforcement has investigated other allegations made by C1 and has found no evidence of wrong doing. Based on interviews with staff, there have been no instances where staff were not professional with clients. Based on interviews with staff, C1 is not a good historian and will changes facts and people and make up things that are not true. Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20230725124319

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 LIFE CARE HOME	FACILITY NUMBER: 486830724
	VISIT DATE: 10/03/2023

NARRATIVE

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LPA attempted to interview other residents in the home, but was not able to gather any helpful information. LPA received copies of C1's behavioral plans which outline ways staff can manage behaviors when they arise. Staff also keep logs of when and what behaviors occur. Facility continues to work with all the involved parties to address clients needs.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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