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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208861
Report Date: 06/03/2021
Date Signed: 06/10/2021 01:52:31 PM

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 LLC - HOUSTONFACILITY NUMBER:
107208861
ADMINISTRATOR:GONZALES, MARILENFACILITY TYPE:
740
ADDRESS:2660 EAST HOUSTON AVETELEPHONE:
(559) 259-6228
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 6DATE:
06/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:51 PM
MET WITH:Administrator, Marilen GonzalesTIME COMPLETED:
02:30 PM
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On 06/03/2021, Licensing Program Analyst (LPA) A. Walton arrived at the above facility unannounced to conduct an Infection Control Inspection. LPA introduced self, stated the purpose of the visit and requested to speak with the Administrator. Facility staff contacted the Administrator, Marilen Gonzales, who arrived at the facility approximately 15 minutes later. Facility has one central entry and exit. Visitor log/temperature check observed at the front entrance.

LPA conducted a facility tour with Administrator. Facility appeared to be clean and all exits were free from obstructions. There are 6 residents present during today's inspection. Staff were observed to be wearing facial masks. Residents observed to be at least 6 feet apart in common areas. Facility is sanitized at least once daily. LPA observed one hand sanitizer dispenser located at the main entrance. LPA did not observe signs promoting handwashing, cough/sneeze etiquette, and physical distancing. Administrator stated the signs "fell down", but, will be replaced. Facility did not have signs posted to notify visitors of policies and procedures.

LPA toured the resident bedrooms. LPA observed at least 6 feet between beds in the shared bedroom. Resident bathrooms were equipped with paper towels and liquid soap. Handwashing signs were not observed in the bathrooms.

LPA observed an adequate supply of food. Cleaning and PPE supplies was observed. Facility has a 30 day supply of resident medications.

LPA reviewed personnel records for good health and infection control training. Resident records have updated emergency contact information. Administrator certificate is current.

Continued to LIC809-C
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: BELLA CARE HOME LLC - HOUSTON
FACILITY NUMBER: 107208861
VISIT DATE: 06/03/2021
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Exterior tour conducted. LPA observed a 1-inch by 1-inch opening in the bottom left corner of the window screens in bedroom 2 and bedroom 3.

No deficiencies issued during today's inspection.

Administrator was informed that a copy of this report will be provided via email due to COVID-19 and precautionary measures and an electronic read receipt confirms receiving this document. Facility representative signature on file.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
LIC809 (FAS) - (06/04)
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