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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600216
Report Date: 06/08/2024
Date Signed: 06/08/2024 04:11:35 PM


Document Has Been Signed on 06/08/2024 04:11 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:STRATA BELLA HOMEFACILITY NUMBER:
198600216
ADMINISTRATOR:BELLOSILLO, JOHNETTEFACILITY TYPE:
735
ADDRESS:23217 HUBER AVENUETELEPHONE:
(310) 534-8453
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:4CENSUS: 4DATE:
06/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:JOSEPHINE SIANATIME COMPLETED:
04:40 PM
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On 06/08/24 Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced required annual visit using the new CARE Inspection Tools. Upon arrival at the facility, Josephine Siana Caregiver called the Administrator Kristel Joy de la cruz. LPA explained the purpose of this visit to the licensee and was granted entry.

The facility has an approve mitigation plan report. LPA Richard and Staff Siana, toured the inside and outside grounds of the facility.

The facility is licensed to serve four (4) non-ambulatory clients ages 18-59, approved for non-ambulatory with a hospice waiver of two clients. The facility is vendored by the Harbor Regional Center. During the tour, LPA observed PPE supplies are readily available to staff, and an additional 30-day supply of PPE is stored in the garage. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility has one central entry and a designated visitation area. LPA observed required postings throughout the facility.

LPA observed the facility consists of living room, office area, TV room, kitchen, dining area, medication closet, two (2) bathrooms, four (4) client bedrooms, washer and dryer in garage, two (2) garages (one used for storage), and backyard.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: STRATA BELLA HOME
FACILITY NUMBER: 198600216
VISIT DATE: 06/08/2024
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Centrally stored medications are inaccessible to clients. Disinfects, cleaning solutions, detergent, toxins are inaccessible to clients. There is at least a one week supply of nonperishable and two day supply of perishable foods. The facility is maintained at a comfortable temperature. The hot water temperatures in both bathrooms measures at 110. 5F degrees Fahrenheit. There are working lights in each room to ensure safety and comfort for all clients in the facility. The clients have clean linen which includes blankets/bedspreads, top and bottom sheets, pillowcases, and mattress pads. First aid kit had the required items. The facility has a written emergency disaster plan located in hallway. This facility has three operable carbon monoxide detectors located in the hallway room and a client's bedroom, operable smoke detectors in all the bedrooms. LPA observed one (1) fire extinguisher located in the kitchen was serviced on 02/24.

No deficiencies were cited. Exit interview conducted and a copy of this report was provided to and signed by Caregiver Josephine Siana to give to the administrator Kristel Joy De La Cruz.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2024
LIC809 (FAS) - (06/04)
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