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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209192
Report Date: 10/03/2026
Date Signed: 10/03/2026 12:20:09 PM

Document Has Been Signed on 10/03/2026 12:20 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:BRIGHTON MANORFACILITY NUMBER:
157209192
ADMINISTRATOR/
DIRECTOR:		ANDERSON, ROSANDAFACILITY TYPE:
740
ADDRESS:305 ALUM BAY COURTTELEPHONE:
(661) 589-1500
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 4DATE:
10/03/2026
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Sally JacksonTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 10/03/2026, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Case Management for health and safety of residents in care. LPA arrived , introduced self, stated purpose of visit and allowed entrance by caregiver. House Manager, Sally Jackson contacted by telephone and arrived 1 hour later to conduct visit with LPA.

LPA conducted visit to follow up on a self reported incident received in Fresno Regional office on 10/03/26. It was reported that on 9/27/2026, staff 1 (S1) who worked the 3:00PM - 11:00PM left the facility unattended with residents in care when the next shift did not arrive on time. S1 contacted staff 2 (S2) regarding situation and S2 arrived to facility to discover residents were without care and supervision. Incident was reported to law enforcement and Long Term Care Ombudsman.

Currently, there are 4 residents in care, there are no residents on hospice or receiving home health services. LPA observed facility to be clean and a comfortable temperature during visit. Facility has a 2-day supply of perishable food and a 7-day supply of non-perishable food.

LPA observed 3 residents to be relaxing in the family room watching television and 1 resident to be relaxing in their bedroom.

Exterior of facility toured, all exits open free of obstruction. During outside tour, LPA observed a single recliner in need of cleaning or removal on back patio, the double garage door to be broken and inoperable. Garage observed to have excess storage of supplies and equipment and in need of cleaning and organizing. LPA observed miscellaneous furniture items outside of the single garage in the driveway in need of removal. .

Continued on 809-C
See Moua
Melinda Medina
DATE: 10/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: BRIGHTON MANOR
FACILITY NUMBER: 157209192
VISIT DATE: 10/03/2026
NARRATIVE
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LPA received the following documents during the visit:
  • LIC 500 - Personnel Report
  • LIC 9020 - Register of Facility Clients/Residents
  • Training agenda for Care and Supervision, training to be conducted by facility prior to 10/07/2026.

Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 9099D. An immediate Civil Penalty is being Assessed on the attached LIC421M and LIC421FC.

Exit interview conducted. A copy of signed report and Appeal rights provided to House Manager for facility records.
NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Melinda Medina
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/03/2026 12:20 PM - It Cannot Be Edited


Created By: Melinda Medina On 10/03/2026 at 10:44 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: BRIGHTON MANOR
FACILITY NUMBER: 157209192

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2026
Section Cited
HSC
1569.2(c)

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(c) “Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance
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Training will be conducted with all staff regarding care and supervision no later than 10/7/2026 and submit sign in sheets to Fresno Regional Office upon completion. Facility provided written agenda for training to LPA during visit.
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with taking medications, money management, or personal care. ***This was not met as evidenced by it was self reported that on 9/27/2026, staff 1 left the facility unattended with residents in care when the next shift did not arrive on time.
IMMEDIATE CIVIL PENALTY ASSESSED
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Type B
10/30/2026
Section Cited
CCR87303(a)

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Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Repairs, cleaning and/or removal to be completed and proof of correction to be submitted to Fresno Regional Office by due date.
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**This was not met as evidenced by LPA observation of double garage door being inoperable. Garage in need of cleaning,miscellaneous items outside of garage to require removal. Recliner on back patio in need of clearning or removal.
IMMEDIATE CIVIL PENALTY ASSESSED
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
See Moua
NAME OF LICENSING PROGRAM MANAGER:
Melinda Medina
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2026


LIC809 (FAS) - (06/04)
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