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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200412
Report Date: 10/31/2024
Date Signed: 10/31/2024 01:33:26 PM

Document Has Been Signed on 10/31/2024 01:33 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:BELL'S FAMILY HOME, INC.FACILITY NUMBER:
019200412
ADMINISTRATOR/
DIRECTOR:		DELLA A. BREWERFACILITY TYPE:
735
ADDRESS:4511 MATTIS COURTTELEPHONE:
(510) 336-9865
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 6CENSUS: 4DATE:
10/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Wanda SheppardTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 10/31/2024 at 1:00pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 10/1/2024. LPA met with Wanda Sheppard, Administrator, and explained the purpose of the visit.

The incident occurred on 9/26/2024, where C1 left facility and didn't return. S1 stated C1 stated he wanted to take a trip and bought an airplane ticket and went to Los Angeles. C1's family member purchased train ticket for C1 to return. C1 returned to the facility unharmed on 9/28/2024. LPA reviewed C1's physician report dated 1/24/2024, which indicates C1 is able to leave facility unattended.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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