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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486830724
Report Date: 06/17/2022
Date Signed: 06/17/2022 04:39:56 PM


Document Has Been Signed on 06/17/2022 04:39 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 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:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Arnel SilverioTIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA), Walters arrived unannounced to conduct a Required 1-year annual inspection and was greeted by Staff, The Administrator/Licensee, Arnel Silverio arrived later. At the time of inspection there were two staff providing care and supervision for four clients. This inspection will focus on the infection control of this facility.

LPA toured the facility to ensure that COVID-19 protocols were in place and made the following observations: At the entrance of the facility, signs were posted to encourage the use of mask and to inform visitors of their visitor policy. Once inside the facility, a sign in sheet with screening questions was available. Hand sanitizer and disposable mask are also available for visitors. All staff were wearing mask. Bedrooms were furnished as required per regulation. Bathrooms were equipped with hand washing supplies and paper products. There were handrails and slip mats for client's safety. Signs were posted to encourage hand washing. Per Administrator, the facility is disinfected every shift and after usage, results are documented on a to-do list. Resident's bedroom's are cleaned three times a week by staff. Clients are screened daily for COVID symptoms using an oxygen meter and temperature gun. Facility has developed activities to keep the clients engaged. During inspection client C1 was participating in an art project. An individual activity is customized for each client monthly by a recreational therapist

LPA reviewed 5 staff records which included staff's vaccine information and N95 fit testing confirmation. Personal Protective Equipment and infection control training's were also documented in staff files. Facility has at least 30 day supply of incontinence and personal protective equipment.
No deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022
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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