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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608297
Report Date: 10/19/2020
Date Signed: 10/20/2020 02:10:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:BELLA VISTAFACILITY NUMBER:
197608297
ADMINISTRATOR:BAKER, IANFACILITY TYPE:
740
ADDRESS:1760 N FAIR OAKS AVETELEPHONE:
(626) 794-4103
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:72CENSUS: 46DATE:
10/19/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator / Ian BakerTIME COMPLETED:
04:30 PM
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An informal conference call was conducted today. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s conference call was conducted telephonically. Present in this meeting were Administrator / Ian Baker, Licensing Program Manager (LPM) / Adeline Ho and Licensing Program Analyst (LPA) / Joe Katrdzhyan.
The purpose of the informal meeting was to discuss COVID related items and concerns regarding surveillance testing. The items below were discussed and addressed during today's meeting;
  • Bella Vista is closed for new resident admission as of 10/01/20 and will continue to be closed until Bella Vista complies with regular testing as outlined by Pasadena Public Health Department (PPHD) guidance.
  • LPA and LPM discussed the importance of surveillance testing and following PPHD guidelines and recommendations.
    1. Monitor the spread of the virus in order to isolate the virus and mitigate outbreaks.
    2. 25% of staff must be tested weekly to complete testing of 100% of all staff each month.
    3. 10% of residents must be randomly tested weekly.
    4. If a staff or resident tests positive, the facility must report the result to the licensing agency and PPHD immediately and proceed to response testing.
  • Sunrise Laboratories will be conducting on-site testing on 10/20/20 for residents and staff. Results will be available within a week. LPA requested the Administrator to provide an update to Licensing once results become available.
  • Importance of being responsive to PPHD and include Licensing with correspondence related to surveillance testing.
  • Staff will be testing at free testing sites closer to their homes.
  • LPA and LPM asked to have a back-up laboratory in place in the event Sunrise Laboratories and MD Labs are not able to fulfill testing.
  • LPA forwarded PINs along with information related to a conference call regarding "COVID: Planning for the Influenza Season Amidst the Pandemic", which will be held on 10/21/20, from 1PM - 3PM.
A telephonic exit interview was conducted with Administrator / Ian Baker, and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020
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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