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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700919
Report Date: 04/26/2022
Date Signed: 04/26/2022 10:24:47 AM


Document Has Been Signed on 04/26/2022 10:24 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:VITA BELLA ELDERLY CAREFACILITY NUMBER:
342700919
ADMINISTRATOR:LABELLA, MARKFACILITY TYPE:
740
ADDRESS:4082 73RD STREETTELEPHONE:
(916) 594-7250
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:10CENSUS: 8DATE:
04/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Mark Labella, AdministratorTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Tung Truong conducted an unannounced case management visit to the facility on 4/26/2022 for the purpose of delivering an Order to Licensee/Facility of Immediate Exclusion from Facility. LPA Truong met with Administrator Mark Labella and explained the purpose of today's visit. Staff 1 (S1) is excluded from all facilities.

LPA handed the Order to Licensee/Facility of Immediate Exclusion From Facility letter to Mark and explained that S1 is not allowed in the facility effective immediately.

Exit interview conducted, a copy of this report and the Immediate Exclusion letter, was provided at the conclusion of this visit.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2022
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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