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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006068
Report Date: 11/17/2023
Date Signed: 11/17/2023 03:11:16 PM

Document Has Been Signed on 11/17/2023 03:11 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:BELLA CLARE HOME 2FACILITY NUMBER:
306006068
ADMINISTRATOR:JOSHUA ESTREVILLOFACILITY TYPE:
735
ADDRESS:6892 SAN PADRE CIR.TELEPHONE:
(714) 723-6780
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 4CENSUS: 4DATE:
11/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Joshua EstrevilloTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Donald Bayaua. LPA discussed the purpose of the inspection and Administrator (AD) Joshua Estrevillo was contacted by phone and arrived at 2:40 p.m.

During the inspection LPA and Staff Patricio Villanueva conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:

This is a one-story home with four client bedrooms, six bathrooms, one walk-in closet, one staff office and one staff bedroom. All client bedrooms had the required furnishings. LPA observed all client beds had linens and blankets. LPA observed all windows were screened. The back yard has a shaded sitting area. LPA observed two clients present, and two clients arriving from day program. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 110.6-114.9 F degrees.

LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed at the entrance of the facility. Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Gas burner stove, dishwasher, microwave, washer, and dryer were all inspected. Sharps were observed locked in a kitchen drawer. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients. Medication closet is inside the staff office and was observed to be locked. LPA reviewed four client files and three staff files. LPA interviewed staff and clients present.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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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