331880645-7-27-2023-18-AS-SMAZ-CU5SDA-20230727134650

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880645
Report Date: 07/27/2023
Date Signed: 07/27/2023 01:47:06 PM

Document Has Been Signed on 07/27/2023 01:47 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	BELLA VILLAGGIO		FACILITY NUMBER:	331880645
ADMINISTRATOR:	JIM GERMYN		FACILITY TYPE:	740
ADDRESS:	40235 PORTOLA AVE		TELEPHONE:	(760) 607-5200
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY:	170	CENSUS: 132	DATE:	07/27/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Eloiza Castellanos - General Manager		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit for a required annual inspection. The LPA met with General Manager (GM) Eloiza Castellanos who was informed of the purpose of the visit. At the time of the visit there was (13) staff and (132) total residents present with (31) residents in the memory care unit. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted a staff and resident interviews. LPA observed the following: LPA toured the facility inside and outside with GM Eloiza. The LPA observed a centralized fire alarm/fire extinguisher system and operating carbon monoxide detectors throughout the facility. LPA observed multiple fire extinguishers that are charged and inspected in June 2023. LPA observed hot water temperature at 113 degrees F and observed grab bars and nonskid strips where needed. LPA observed passageways were clear of obstructions and there are rail bars in hallways. LPA was informed this facility does not allow the storage of firearms or ammunition. LPA observed the pool area fenced and locked. Residents in the assisted living unit of the facility have a key fob to access the pool. Residents in the memory care unit do not have access. The LPA observed the ombudsman poster, complaint poster, residents rights and resident council information posted located in both assisted living and memory care. The LPA observed the kitchen and food storage. Food is stored, covered, temped at the proper temperature and is dated. The refrigerator measured 38 degrees F and the freezer measured -15 degrees F. The LPA was informed this facility receives food shipments 3 times a week. There is a sufficient supply of perishable and non-perishable foods to meet the requirements.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BELLA VILLAGGIO	FACILITY NUMBER: 331880645
	VISIT DATE: 07/27/2023

NARRATIVE

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LPA observed medications are kept locked in the medication rooms and medication carts. LPA observed the facility utilizes an eMARS for documentation of the distribution of medication. LPA observed all medications listed on MARS and all required labeling was found to be in place.

Facility has adequate supply of linens and towels for use by the residents and were sufficient to meet the needs of the residents. LPA observed laundry rooms which had operating washers and dryers for residents use. Laundry room in the memory unit is locked at all times and only accessible to staff.

LPA reviewed five (5) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Five (5) resident files were reviewed, and possessed all required paperwork.

LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire and earthquake drills, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in a storage room and first aid kit with all required items.

No deficiencies were cited at the time of the visit.

An exit interview was conducted where a copy of this report was provided to General Manager Eloiza Castellanos.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC809 (FAS) - (06/04)

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