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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208815
Report Date: 12/22/2022
Date Signed: 12/23/2022 09:45:19 AM


Document Has Been Signed on 12/23/2022 09:45 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 VITA AT STONINGTONFACILITY NUMBER:
157208815
ADMINISTRATOR:LOPEZ, ERICFACILITY TYPE:
740
ADDRESS:11711 STONINGTON STREETTELEPHONE:
(661) 319-6103
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 4DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Eric LopezTIME COMPLETED:
02:08 PM
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On 12/22/22, Licensing Program Analyst (LPA) M. Medina arrived at the facility unannounced to conduct a annual infection control inspection. LPA was greeted by Caregiver and stated the purpose of the visit, and allowed entry into the facility. Licensee/Administrator, Eric Lopez arrived a short time later to conduct inspection. Front door is facility main entry point, LPA observed the Staff and Visitor sign in and COVID Screening area.

Facility Mitigation plan has been submitted to CCL. Infection control procedures described in the plan which were observed and reviewed by LPA include: Daily symptoms screenings (for staff, persons in care and visitors), testing, visitation, quarantine/isolation procedures, emergency staffing plan, PPE storage, use and training, as well as daily infection control procedures. Administrator is identified as the Infection Control Lead for the facility.

LPA toured the facility inside and out. Postings to encourage face coverings and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Staff were all observed wearing face coverings. Facility has multiple designated visitation areas available. LPA observed 30-day medication supply and PPE accessible to staff. Common and resident bathroom sinks are stocked with liquid soap and paper towels for hand washing.

Through LPA’s observations, documentation review and interview with Licensee, the required infection control practices are found to be in compliance. No deficiencies cited on todays visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2022
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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