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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701192
Report Date: 10/20/2023
Date Signed: 10/20/2023 12:58:48 PM


Document Has Been Signed on 10/20/2023 12:58 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:VITA BELLA ELDERLY CARE IIIFACILITY NUMBER:
342701192
ADMINISTRATOR:LABELLA, MARKFACILITY TYPE:
740
ADDRESS:6700 SUN RIVER DRTELEPHONE:
(916) 490-0237
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:14CENSUS: 13DATE:
10/20/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Kayia SharpTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Pang Lee arrived at the facility on 10/20/2023 at 10:35 AM to conduct an unannounced Plan of Correction (POC) visit. LPAs Lee met with direct care staff, Kayia Sharp and explained the purpose of the visit. The purpose of this visit is to follow-up on plan of corrections that were due on 10/03/2023. During today's visit, LPA Lee toured and inspected the facility to ensure all deficiencies previously cited have been corrected. The census is 13 with three care staff. Administrator, Mark Labella was not present during today visit.

Based upon this inspection, the LPA observed the following:

I. Deficiency cited under Title 22 Regulation 87202 has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee.

II. Deficiency cited under Title 22 Regulation 87202(a) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to care staff, Kaydia Sharp.

An exit interview was held, and a copy of this report LIC 809, was given to direct care staff, Kaydia Sharp at the end of the visit.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2023
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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