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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208861
Report Date: 07/06/2023
Date Signed: 07/06/2023 04:39:34 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/06/2023 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
SIERRA CASCADE AC/SC, 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:
07/06/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Phillip GonzalesTIME COMPLETED:
04:15 PM
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This annual evaluation report is continuation of annual visit the original report started on 5/09/22.
FAS did not have an option to create new annual visit form. LPA created case management - annual continuation for 2023 annual evaluation visit.

On 07/06/2023, Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct a required annual inspection. LPA met with Administrator Phillip Gonzales and announced the purpose of the visit.

LPA toured the facility inside and outside. Backyard had emergency exit rout accessible to residents. The facility was at a comfortable temperature and adequately furnished. All passageways and exits were clear and free from obstruction. Facility had carbon monoxide and smoke detectors which were functioning. Water temperature in the bathroom tested of 111 degrees. Facility fire extinguisher was serviced on 5/31/23. The facility phone was functioning. LPA toured resident bedrooms and bathrooms. All 5 residents’ bedrooms were adequately furnished and lit. Bathrooms were clean, odor free, and all fixtures were functioning properly. LPA observed two-day supply of perishable food stuffs and seven-day supply of non-perishable food stuffs. Sharp items were secured in a locked drawer in the kitchen. Medications were locked in a cabinet in the kitchen and appear to be administered properly. LPA reviewed Staff and Resident files.
Garage is not utilized for any functions or activities.

No deficiencies were cited during the inspection. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023
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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