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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608649
Report Date: 07/28/2022
Date Signed: 07/28/2022 03:16:28 PM

Document Has Been Signed on 07/28/2022 03:16 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:BELLA HOME CARE SERVICESFACILITY NUMBER:
197608649
ADMINISTRATOR:ROWENA FLORESFACILITY TYPE:
735
ADDRESS:831 IROLO STREETTELEPHONE:
(213) 263-2258
CITY:LOS ANGELESSTATE: CAZIP CODE:
90005
CAPACITY: 6CENSUS: 6DATE:
07/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Rowena FloresTIME COMPLETED:
03:20 PM
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Licensing Program Analysts (LPAs) Nune Margaryan and Ya Ting Yang conducted an annual required visit. LPA met with staff Rowena Flores and explained the reason for the visit. LPAs used the infection control tool to evaluate the facility. The physical plant was inspected along with COVID-19 procedures, medications, food supply, and clients and staff records. The facility has an approved mitigation plan on file. The facility is licensed to serve mentally disabled adults ages 18-59 and vendorized by Frank Lanternman Regional Center.
LPAs toured the home and inspected 3 client bedrooms, 2 client bathrooms, kitchen, dining room, living room, office and detached garage. Laundry area is located in the backyard. There are no pools or large bodies of water. There is a shaded seating area for the residents located in the patio area. Passageways and exits are free of obstruction. LPAs observed a fireplace in the living room which secured with the metal screen. The common areas are clean and have the required furniture.
There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPAs were screened upon entry. All staff were observed to be wearing mask upon entrance and during visit.
Client bedrooms were checked. Each bedroom is equipped with the proper furnishings. The bathrooms were toured. Bathrooms are clean and have the required hygiene items. The hot water temperature was tested and was measured within Title 22 Regulation guidelines. Cleaning supplies are inaccessible to clients. The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are clean and working properly. Knives are locked in the kitchen cabinet inaccessible to clients.

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SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME CARE SERVICES
FACILITY NUMBER: 197608649
VISIT DATE: 07/28/2022
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LPAs observed the centrally stored medication cabinet to be locked in the kitchen cabinet and inaccessible to clients. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. The carbon monoxide detector / smoke detectors were observed in the hallway and in the clients room working properly. Fire extinguishers observed fully charged and operational.

LPA reviewed client files to confirm emergency contacts have been updated. LPA confirmed staff working have fingerprint clearances. LPAs reviewed clients medications. Medications are documented properly and given as prescribed.



No deficiency was observed during today's visit. Exit interview was conducted with the Administrator and a copy of report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC809 (FAS) - (06/04)
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