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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577005047
Report Date: 08/15/2024
Date Signed: 08/15/2024 11:42:28 AM


Document Has Been Signed on 08/15/2024 11:42 AM - 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:BRIDGEWAY CAREFACILITY NUMBER:
577005047
ADMINISTRATOR:RAMON SILVESTREFACILITY TYPE:
740
ADDRESS:2512 MEADOWLARK CIRCLETELEPHONE:
(916) 239-8948
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:6CENSUS: 5DATE:
08/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Ramon Silvestre, AdministratorTIME COMPLETED:
11:42 AM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Required inspection and met with Elizabeth Miranda, caregiver/assistant to the Licensee and Ramon Silvestre, Administrator.

There were 2 caregivers and 5 residents at the time of inspection. All residents were clean and appropriately dressed. Required postings were present on hallway at entrance ot facility. The facility was clean and well-organized. There was an abundance of fresh fruits and vegetables, perishable and non-perishable foods. Food stored in refrigerator was dated and appropriately sealed. The bathrooms were clean and sanitary and had the required grab bars/non-slip mats. The facility provides a land line phone for residents to stay in touch with family and friends. There was a newly purchased Fire Extinguisher that was charged and operational. Fire department inspected the fire sprinklers and fire alarm system on 03/25/2024 and found it operational. Each resident had the required furnishings. There was an ample supply of linens. The back yard was well-maintained and there is a shaded area with table and chairs for residents to enjoy and visit with guests.

File review of 5 residents and 4 employees was conducted and found all files complete.

There were no deficiencies found at the time of inspection. No citations issued.

Exit interview conducted with Ramon Silvestre, whose signature on this document confirms receipt.

SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2024
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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