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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426776
Report Date: 08/28/2024
Date Signed: 08/28/2024 11:47:35 AM


Document Has Been Signed on 08/28/2024 11:47 AM - 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:BELLA CASA 2FACILITY NUMBER:
336426776
ADMINISTRATOR:CARLOS, ROMMELFACILITY TYPE:
740
ADDRESS:77-632 BARONS CIRTELEPHONE:
(760) 772-5089
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY:6CENSUS: 5DATE:
08/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Carlos Rommel, administratorTIME COMPLETED:
11:57 AM
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Licensing Program Analysts (LPAs), Seo Jeon and Ferrer Sabarias made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA were greeted and allowed to enter the facility to conduct the inspection. On today’s visit the LPA met with Administrator, Ursula Carlos, She was notified of the purpose for the visit.

The facility is a one story home with (5) bedrooms and (3) bathrooms with attached garage. The facility does not have a pool or any body of water. LPAs conducted a tour of the interior and exterior, reviewed facility documents, and observed the following:

The Licensee is operating the facility within the conditions and limitations specified on the license. Clients appear to be protected against immediate hazards. Outdoor and indoor passageways are kept free of obstruction. According to staff, there are no known weapons kept in the home. Disinfectants, cleaning solutions, and poisons were inaccessible to clients in care. A comfortable temperature was being maintained in the home. There was sufficient lighting in all rooms to ensure the comfort and safety of clients. Hot water was tested and observed to be within regulatory requirements at 109.9 degrees F. Toilets, hand washing and bathing facilities were kept safe, sanitary, and in operating condition. Additional equipment for physically handicapped clients is available. The smoke and carbon monoxide alarms were tested and found to be operable. The interior and exterior areas of the home were observed to be very clean and safe.

There was a variety of food which appeared to be selected and stored in a safe and healthful manner. Food supply of nonperishable and perishable foods was sufficient. The kitchen was observed to be clean.

Continued on LIC809-C.....

SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Seo JeonTELEPHONE: 951-248-0309
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BELLA CASA 2
FACILITY NUMBER: 336426776
VISIT DATE: 08/28/2024
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LPA reviewed (3) staff files and reviewed the facility's staff schedule. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Three (3) client files were reviewed, and possessed all required paperwork.

Medications were reviewed for three clients in care. All medications were labeled and maintained in compliance with label instructions. Medications were observed to be safe, locked, and inaccessible to clients in care. Medications and medication documentation were observed to be well organized and monitored.

LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility performs quarterly fire and earthquake drills, which met the department requirements. LPA observed all facility exits were clear from obstructions. Fire extinguisher located in the kitchen area had current inspection tag.

No deficiencies were cited per Title 22, Division 6 of the California Code of Regulations at this time.



An exit interview was conducted where a copy of this report was provided to the administrator, Ursula Carlos.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Seo JeonTELEPHONE: 951-248-0309
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2