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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700921
Report Date: 01/30/2025
Date Signed: 01/31/2025 09:58:26 AM

Document Has Been Signed on 01/31/2025 09:58 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:VITA BELLA ELDERLY CARE IIFACILITY NUMBER:
342700921
ADMINISTRATOR/
DIRECTOR:		MARK LABELLAFACILITY TYPE:
740
ADDRESS:8362 NEW POINT DRTELEPHONE:
(916) 667-8409
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 6CENSUS: 6DATE:
01/30/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Mark Labella, Cleopatra Gardiner, Marie Ann Taylor and Aliti WagalalaTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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A Non-Compliance Conference (NCC) was conducted today on January 30, 2025, via Microsoft Teams with the Sacramento South Regional Office. The purpose of this Non-Compliance Conference meeting to discuss compliance issues at the facility and the steps the facility is taking to address the Departments’ concerns. Present in the meeting is Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Czarrina Camilon-Lee, Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Analysts (LPA) Pang Lee, Licensee Mark Labella, Administrator Cleopatra Gardiner, Staff Marie Ann Taylor, and Staff Aliti Wagalala. During this virtual meeting, the Non-Compliance Conference process was explained to the Licensee. A Non-Compliance Conference Summary (LIC 9111) was generated to document this office meeting. A copy of this report and the LIC 9111 was provided to the licensee. The facility has previously received 1 Type A citations and 6 Type B citations since 12/22/2021.

Issues discussed during the meeting were:
· Basic Services (care/supervision/elopement)
· Administrator qualifications/duties and accountability/new potential administrator
· Reporting requirements
· Incidental Medical and Dental Care Services (resident not receiving medication as prescribed)
· Fire clearance (adhering to fire clearance/submitted facility sketch)
· Limitations capacity and ambulatory status (non-ambulatory resident cannot reside in an ambulatory room)

· Plan of corrections (POCs) submitted in a timely manner.

· Background/fingerprint clearance (volunteers)

· Maintenance and building (self-latch and close gate)

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: VITA BELLA ELDERLY CARE II
FACILITY NUMBER: 342700921
VISIT DATE: 01/30/2025
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· Increased training for incidental medical and dental care (ensuring residents are given medications as prescribed)

· Increased training for storage space (cleaning supplies/toxin needs to be inaccessible to residents)

· Resident assessment prior to admission and appraisals based on residents change of conditions.

The facility has stated they will agree to do the following:

· Licensee agrees to ensure gates in the facility are self-latch/close by 02/06/25.


· Licensee agrees to conduct incidental reporting training to all facility staff and provide CCLD training materials used for the training and training sign in sheets. Training will be conducted every 6 months.
· Licensee agrees to conduct incidental medical training to all facility staff and provide CCLD training materials used for training and training sign in sheets. Training will be conducted every 6 months.
· Licensee agrees to submit an addendum for volunteers in the facility.

Notwithstanding the above statement, the Department will take the following actions:
· The facility will continue to have additional monitoring and facility inspections to verify improvement in compliance.
· Licensee stated that he will be meeting up next week with his administrator and potential administrators to discuss TSP and will reach out to LPA.

Failure to maintain substantial compliance outlined on the LIC 809 reported will result in the Licensee/Facility being referred to the Legal Department for review and possible Administrative Action. The RO will revisit compliance in 9-12 months and begin the legal process if the facility is not in compliance. An exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC809 (FAS) - (06/04)
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