<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206822
Report Date: 04/15/2024
Date Signed: 04/15/2024 11:10:21 AM


Document Has Been Signed on 04/15/2024 11:10 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, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:BELLA CARE HOME LLCFACILITY NUMBER:
107206822
ADMINISTRATOR:MARILEN GONZALESFACILITY TYPE:
740
ADDRESS:491 PIERCE DRTELEPHONE:
(559) 472-3575
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:6CENSUS: 5DATE:
04/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Licensee/Administrator Marilen Gonzales and Staff Ann LorioTIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by Staff Erica Ocariza and explained the purpose of the visit. Licensee/Administrator Marilen Gonzales responded to the facility to assist with the visit.

The residence was set at 73 degrees F temperature and free of passageway obstructions inside and outside. LPAs observed five bedrooms in the residence. Facility is two story. Upstairs is designated for staff only. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Hot water temperature was measured at 115.4 degrees F.

Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in a kitchen cabinet. Cleaning supplies were locked in the hallway closet. Smoke and carbon monoxide are dual detectors, they were checked and operating. Fire extinguishers was service on 2/5/2024. Last drill completed on 02/02/24. There was outdoor seating for the residents. Outdoor area was clean and free of obstruction.

Facility has a pool which is gated, locked and inaccessible to residents in care.

Resident and staff records were reviewed. Medications were reviewed.

An exit interview was conducted with Staff Ann Lorio, and a copy of this report was provided.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1