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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208815
Report Date: 12/10/2024
Date Signed: 12/10/2024 01:02:00 PM

Document Has Been Signed on 12/10/2024 01:02 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:BELLA VITA AT STONINGTONFACILITY NUMBER:
157208815
ADMINISTRATOR/
DIRECTOR:
LOPEZ, ERICFACILITY TYPE:
740
ADDRESS:11711 STONINGTON STREETTELEPHONE:
(661) 368-2233
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
12/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:04 AM
MET WITH:Eric LopezTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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
On 12/10/24, Licensing Program Analyst (LPA) M. Medina made an unannounced Annual Required Inspection. LPA arrived, introduced self, and stated purpose of visit. LPA was allowed entrance by Licensee/Administrator, Eric Lopez.

Currently, five (5) residents in care. The facility is a 5 bedroom, 3 bathroom home. Facility toured with Administrator, facility observed to be clean, well lit, odor free, and a comfortable temperature. Resident bedrooms are all private. All resident bedrooms observed to have required accommodations. All common areas of the facility have sufficient lighting and seating for all residents in care. Residents bathrooms observed to be clean and in good repair. Bath/tub are have non-skid mats and grab bars. Hot water measured at 114 degrees F. Tour of kitchen conducted. LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available for the residents in care. Medications observed to be locked in cabinet in laundry area. All medications observed to have original labels and observed to be administered as prescribed.

Carbon monoxide detector and smoke detectors tested and observed operational at time of inspection. Fire extinguisher has a purchase date of 10/15/2024. All chemicals observed to be locked and secured in laundry room. Last Fire drill conducted on 10/01/24, according to facility records

Outside areas toured. All exits open freely and observed to be free of obstruction. No hazards observed.

Resident and staff files reviewed. Facility provided the following forms to LPA during facility inspection: LIC308, LIC309, LIC500, LIC9020, Certificate of Liability Insurance, and current Administrator certificate.

No deficiencies cited. Exit interview conducted, and copy of report provided to Licensee via e-mail.
Melinda HoffmannTELEPHONE: (559) 341-3247
Melinda MedinaTELEPHONE: (559) 410-5914
DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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