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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600775
Report Date: 08/23/2024
Date Signed: 08/23/2024 02:58:16 PM

Document Has Been Signed on 08/23/2024 02:58 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:STRATA BELLA (NORWALK) CORPORATIONFACILITY NUMBER:
198600775
ADMINISTRATOR/
DIRECTOR:		RUDY DEOCAMPOFACILITY TYPE:
735
ADDRESS:13213 FLALLON AVENUETELEPHONE:
(562) 864-9803
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 3DATE:
08/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:13 PM
MET WITH:Johnette Bellosillo, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) S Vaid conducted a site visit for the annual inspection. Upon arriving at the facility LPA met with Johnette Bellosillo (Licensee) and explained the purpose of the visit. Licensed to serve four (4) developmentally disabled adults; three (3) can be non-ambulatory. Todays census is three (3) clients. Clients are Harbor Regional Center.

The facility is located in a residential area. A tour of the single-story facility includes: Living room, kitchen, dining area, 4 client bedrooms, 1 staff room, 2 bathrooms and an attached garage.

During today’s visit, LPA utilized the Compliance and Regulatory Enforcement tool. Interviewed two (2) staff and two (2) clients, third client was at day program and was not interviewed. Reviewed three staff (3) files no issues observed. Reviewed three (3) client files, no issues were observed.

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting clients’ medications. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan.
Physical Plant & Environment Safety: There are 4 client bedrooms, 2 bathrooms 1 staff room/office, living room, dining area, kitchen, attached garage with laundry, front yard, and backyard. Bathrooms are clean and operational. Clients’ bedrooms were checked and furnishings are one bed, night stand, sitting chair, lamp. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility and there are no weapons on the premises. Hygiene products are readily available and stored in a storage closet. The hot water temperature was tested in all bathrooms and the kitchen was measured within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are stored in a secured/locked area in the kitchen and inaccessible to clients. The last Fire/Emergency Drill was conducted on 02/18/2024. Smoke detectors and carbon monoxide detectors are operable and in compliance. The fire extinguisher was observed and is fully charged and was last serviced on 04/18/2024.
CONTINUED ON 809C.....
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: STRATA BELLA (NORWALK) CORPORATION
FACILITY NUMBER: 198600775
VISIT DATE: 08/23/2024
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Operational Requirements: The facility has an approved fire clearance and outdoor activity area that is shaded and furnished for outdoor use. Staffing: There appears to be sufficient staffing at all times in the facility. Administrator Johnette Bellosillo certificate expires 01/23/2025. Personnel Records-Training: Staff has criminal record clearance, current first aid and CPR, and ongoing training. Staff files are maintained at the facility and kept in the staff office. Client Rights-Information: Clients are provided with telephone and internet at the facility. Client Records-Incident Reports: Client files are kept in a secure location within the staff office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables.
Health Related Service: Staff designated to administer medication has the proper training on file. Medication is properly labeled and are centrally stored in a locked cabinet and are in their original containers. During the visit today, LPA reviewed 3 clients’ medication no issues were observed.
Incidental Medical & Dental: All medications for clients are kept locked and inaccessible to other clients.
Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Emergency Intervention: Clients at this facility do not use restraints nor are they require the use de-escalation techniques.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit.

Exit interview held and a copy of the report was provided to Administrator Johnette Bellosillo.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC809 (FAS) - (06/04)
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