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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804244
Report Date: 07/09/2024
Date Signed: 07/09/2024 12:36:00 PM


Document Has Been Signed on 07/09/2024 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:BRIGHT HORIZONS CARE HOME - SANTA ROSAFACILITY NUMBER:
496804244
ADMINISTRATOR:SILVERIO, JUSTINE FELEZEFACILITY TYPE:
740
ADDRESS:1022 HYLAND DRIVETELEPHONE:
(858) 837-1138
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:4CENSUS: 0DATE:
07/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Applicants, Justine Silverio and Arnel SilverioTIME COMPLETED:
12:40 PM
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At approximately 8:20AM, Licensing Program Analyst (LPA) Felias arrived announced to conduct a Pre-Licensing Inspection and met with Applicants, Justine Silverio and Arnel Silverio. Upon arrival, LPA was informed that there were currently no residents in care. Facility received an approved fire clearance dated 04/02/2024 that allows for a total capacity of 4 non-ambulatory residents. Facility also has a hospice waiver for 2 individuals. Facility plans to care for older adults with intellectual and developmental disabilities.

LPA conducted a walk-though of facility with Applicants and observed the following: Per facility sketch, facility is a one story residence with 4 resident bedrooms, two bathrooms, 1 staff room, and common areas. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Facility's hot water temperatures for all sinks were within Title 22 Regulations of 105F to 120F. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. All resident rooms were furnished per regulation with a bed, lamp, dresser, chair and bedside table. Facility has sufficient items for cooking and eating. Facility has a locked cabinet located in the kitchen for centrally stored medications. Facility files will be in a cabinet located in the front room. Facility has indoor/outdoor areas for visiting and activities. Facility's fire extinguishers were inspected May 2024. Facility's combination smoke and carbon monoxide detectors were tested and operational. LPA confirmed that contents of the facility's First Aid Kit were sufficient. Component III was reviewed with Applicants.

No Deficiencies or Advisories given during visit. Pre-Licensing completed. Facility is ready to be Licensed as a Residential Care Facility for the Elderly. LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status.

Exit interview conducted. Copy of report discussed and provided to Applicants. Signature on form confirms receipt of documents.

SUPERVISOR'S NAME: Victoria BertozziTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Caitlynn FeliasTELEPHONE: 707-588-5039
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
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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