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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602253
Report Date: 01/26/2026
Date Signed: 01/26/2026 02:43:53 PM

Document Has Been Signed on 01/26/2026 02:43 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:BELLA VISTA AT LINCOLNFACILITY NUMBER:
198602253
ADMINISTRATOR/
DIRECTOR:		HAMILTON, MARKFACILITY TYPE:
735
ADDRESS:2612 N LINCOLN AVETELEPHONE:
(626) 798-9118
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 50CENSUS: 30DATE:
01/26/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Supervisor, Amada Lopez, Direct Support Professional, Colin Jones & Administrator, Kim CommodoreTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 1/26/2026, Licensing Program Analysts (LPAs) Antonia Alvizar-Ettima and Angelica Segovia conducted an unannounced required annual visit to the facility. LPAs met with both Direct Support Professional and Supervisor. LPAs explained the reason for their visit. The Administrator arrived shortly after to assist with today’s visit. LPAs utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today.

A physical plant tour was conducted at approximately 10:15AM with the Supervisor and Direct Support Professional for compliance with safety, maintenance and operational requirements. The following was noted:

Main Building:

There is one (1) main entrance at the facility and there are required posters posted at the main door. Facility is a single-story residence and consists of eight (8) bedrooms and six (6) bathrooms currently occupying twelve (12) female clients and two (2) male clients. There is no designated staff room. The facility maintains a comfortable temperature at 73°F. The smoke detectors and Carbon Monoxide detectors were tested and function properly. Fire extinguishers are located in the common areas and at the end of the hallway near the bedrooms. Fire extinguishers were fully charged and tag date is 12/22/2025. Cleaning supplies and toxic substances are inaccessible to clients. Kitchen: The kitchen appeared to be clean and the appliances and fixtures functional. This kitchen is used to prepare and cook all meals for clients in care. LPAs observed there to be sufficient amount of perishable and non-perishable food at the facility. Additional food was observed to be properly stored in both the laundry room and basement. Sharp objects are stored and locked in a drawer in the kitchen.

Cont. on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Antonia Alvizar-Ettima
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2026
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BELLA VISTA AT LINCOLN
FACILITY NUMBER: 198602253
VISIT DATE: 01/26/2026
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Cont. from LIC 809

Bedrooms: The clients’ bedrooms were properly furnished. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads and blankets. Bathrooms: LPAs observed all bathrooms to be clean, properly supplied and had functional fixtures. LPA's observed grab bars and non-skid mats in all bathrooms. Clients have sufficient amounts of supplies for personal hygiene. The hot water was measured within title 22 regulations. Medication Room: LPAs observed medications to be kept locked, placed in two (2) carts and inaccessible to clients. All clients’ medications were delivered from the pharmacy in bubble packs. Randomly selected clients’ medication was reviewed and appeared to meet Title 22 Requirements. There were three (3) complete first aid kits in the medication room located in the main building adjacent to the main office. The garage was converted into a laundry area which is located between Annex A and Annex B. LPAs observed the garage to be used for storage purposes such as linens and an extra freezer with sufficient food for clients. LPAs observed the laundry detergents, cleaning agents and other toxins to be stored in a locked cabinet inaccessible to clients. Ventura House: Facility is a single-story residence and consists of; three (3) bedrooms, one (1) bathroom, activity room, a screened porch, a dinette and kitchen that is not used. Currently occupying two (2) male Client. There is no designated staff room. The facility maintains a comfortable temperature at 74°F. The smoke detectors and Carbon Monoxide detectors were tested and function properly. Fire extinguishers are located in the common area and at the end of the hallway near the bedrooms. Fire extinguishers were fully charged and tag date is 12/22/2025. Cleaning supplies and toxic substances are inaccessible to clients. Bedrooms: The clients’ bedrooms were properly furnished. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathroom: LPAs observed bathroom to be clean, properly supplied and had functional fixtures. LPAs observed grab bars and non-skid mats in bathroom. Clients have sufficient amounts of supplies for personal hygiene. The hot water was measured within title 22 regulations. Common Areas: These include the activity room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality. All areas were clean, sanitary and in good repair. Annex B: Facility is a single-story residence and consists of: five (5) bedrooms, two (2) bathrooms and a hall. Currently occupying zero (0) clients. There is no designated staff room. Fire extinguishers were fully charged and last purchased on 12/22/2025. Bedrooms: The Client bedrooms were properly furnished. The bedrooms had appropriate and adequate bedding and linens such as sheets,

Cont. on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Antonia Alvizar-Ettima
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BELLA VISTA AT LINCOLN
FACILITY NUMBER: 198602253
VISIT DATE: 01/26/2026
NARRATIVE
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Cont. from LIC 809-C

pillowcases, mattress pads, and blankets. Bathrooms: LPAs observed all bathrooms to be clean, properly supplied and had functional fixtures. LPAs observed grab bars and non-skid mats in all bathrooms. Clients have sufficient amounts of supplies for personal hygiene. The hot water was measured and was within required title 22 regulations. Common Area: This include a large hallway. The common area were checked for cleanliness. All areas were clean, sanitary and in good repair. Annex A: Facility is a single-story residence and consists of: five (5) bedrooms, three (3) bathrooms. Currently occupying ten (10) male clients. There is no designated staff room. The facility maintains a comfortable temperature at 75°F. The smoke detectors and Carbon Monoxide detectors were tested and function properly. Fire extinguishers are located in the common area and at the end of the hallway near the bedrooms. Fire extinguishers were fully charged and tag date is 12/22/2025. Cleaning supplies and toxic substances are inaccessible to clients. Bedrooms: The clients’ bedrooms were properly furnished. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads and blankets. Bathrooms: LPAs observed all bathrooms to be clean, properly supplied and had functional fixtures. LPA's observed grab bars and non-skid mats in all bathrooms. Clients have sufficient amounts of supplies for personal hygiene. The hot water was measured within title 22 regulations. Common Areas: These include the recreation/TV room and hallway. The common areas were checked for cleanliness and furniture was checked for functionality. All areas were clean, sanitary and in good repair.

Lincoln House:

Facility is a single-story residence and consists of: four (4) bedrooms, three (3) bathrooms, a living room, a dining room, and a hallway. Currently occupying six (6) female clients. There is no designated staff room. The facility maintains a comfortable temperature at 73°F. The smoke detectors and Carbon Monoxide detectors were tested and function properly. Fire extinguishers are located in the common area and at the end of the hallway near the bedroom. Fire extinguishers were fully charged and tag date is 12/22/2025. Cleaning supplies and toxic substances are inaccessible to clients. Bedrooms: The clients’ bedrooms were properly furnished. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPAs observed all bathrooms to be

Cont. on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Antonia Alvizar-Ettima
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BELLA VISTA AT LINCOLN
FACILITY NUMBER: 198602253
VISIT DATE: 01/26/2026
NARRATIVE
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Cont. from LIC 809-C

clean, properly supplied and had functional fixtures. LPA's observed grab bars and non-skid mats in all bathrooms. Clients have sufficient amounts of supplies for personal hygiene. The hot water was measured within requirement of title 22 regulations. Common Areas: These include the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality. All areas were clean, sanitary and in good repair. Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. File Reviews: LPAs conducted a file review at 1:00PM for clients and staff regularly scheduled. Staff have current first aid and training documentation showing required training completed. Client records were observed to be complete. All clients have current annual physician’s report, appraisal and admission agreements on file. Administrator granted Supervisor to sign this report.

Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, no deficiencies were observed/cited. Exit Interview conducted and a copy of the Report was Issued.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Antonia Alvizar-Ettima
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC809 (FAS) - (06/04)
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