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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600775
Report Date: 10/13/2023
Date Signed: 10/18/2023 02:41:32 PM

Document Has Been Signed on 10/18/2023 02:41 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:STRATA BELLA (NORWALK) CORPORATIONFACILITY NUMBER:
198600775
ADMINISTRATOR:RUDY DEOCAMPOFACILITY TYPE:
735
ADDRESS:13213 FLALLON AVENUETELEPHONE:
(562) 864-9803
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
10/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Johnette BellosilloTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Mercedes Bedolla and explained the purpose for todays visit. Later Johnette Bellosillo arrive and joined the visit. The facility phone number is 562 804 9803

The facility consist of: Living room, kitchen, dining area, 4 client bedrooms, 1 bedrooms, 2 bathrooms and an attached garage.

LPA conducted a complete tour of the facility, and observe the supply of food. LPA observed one fire extinguisher in entry way between the kitchen and living. The water temperature was tested and measured 110.1 degrees F. LPA Wesley requested a copy of the facility infection control plan and the licensee advise she will have it to the department in 1 week. The email address is johnette.bellosillo@strata bella.com

Administrators certificate for Johnettte B Bellosillo 6023643735, expires on 1/23/25.

Due to time constraints, LPA will return at a later date to complete the inspection.

Exit interview conducted.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2023
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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