107208989-10-13-2022-24-AS-MHON-CKHMNZ-20221024094623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208989
Report Date: 10/13/2022
Date Signed: 10/13/2022 01:45:11 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/31/2022 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220831150226

FACILITY NAME:	BELLA CARE HOME LLC-MATUS		FACILITY NUMBER:	107208989
ADMINISTRATOR:	GONZALES, MARILEN		FACILITY TYPE:	740
ADDRESS:	7947 NORTH MATUS AVE		TELEPHONE:	(559) 259-6228
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	6	CENSUS: 6	DATE:	10/13/2022
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Facility Staff, Erick Khio		TIME COMPLETED:	01:59 PM

ALLEGATION(S):

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Violation of Personal Rights of residents in care

INVESTIGATION FINDINGS:

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On 10/13/2022, Licensing Program Analyst (LPA) A. Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator, Marilen Gonzales was not available during this inspection. LPA received verbal permission via telephone to meet with Facility Staff, Erick Khio.

During the investigation, LPA conducted a facility tour and interviewed residents and staff.

Based on interviews conducted, the allegation: Violation of Personal Rights of residents in care is UNSUBSTANIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies issued during this inspection. An exit interview was conducted. A copy of this report was discussed and provided to Facility Staff, Erick Khio, whose signature on this form confirms receipt of this document.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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