342701192-2-2-2023-27-AS-PLEE-CNNNNG-20230202093642

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701192
Report Date: 02/02/2023
Date Signed: 02/02/2023 09:36:45 AM

Document Has Been Signed on 02/02/2023 09:36 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	VITA BELLA ELDERLY CARE III		FACILITY NUMBER:	342701192
ADMINISTRATOR:	LABELLA, MARK		FACILITY TYPE:	740
ADDRESS:	6700 SUN RIVER DR		TELEPHONE:	(916) 490-0237
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	14	CENSUS: 0	DATE:	02/02/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mark Labella and Penina Tuimaualuga		TIME COMPLETED:	09:45 AM

NARRATIVE

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Licensing Program Analysts (LPA) Avelina Martinez and Pang Lee and Licensing arrived announced to conducted a follow up Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPAs met with Mark Labella and Penina Tuimaualuga who assisted LPAs in today’s inspection.

LPAs toured the facility with Mark Labella and Penina Tuimaualuga. During today's visit, there were a few items that need corrected. The following items that need to be corrected are as follows:

Room 2 window needs to be replaced. Window has crack.
Rooms 1, 2, 3, 5, 10, kitchen windows, dinning room, living room, hallway door
Outside ramp needs to fastened
Room 6,7,8 floor repair was being done during today's walk through.
Room 9 AC protector needs to fasten

Some of the prior corrections will be reviewed at next pre-licensing visit.
Some of the Prior Facility Corrections:

Repair Window in room 1 and 2.
Repair exterior steel gate.
Outside Patio needs a ramp for wheelchair access.
Outside courtyard needs a canopy
Outside gutter need to be repaired
Room needs an electrical cover plate
Updated facility sketch

The Department will return at a later date to complete the pre-licensing. The applicant has not passed the pre-licensing component of the application process today. An exit interview was conducted, and a copy of this report was given to the applicant.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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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