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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701192
Report Date: 02/06/2023
Date Signed: 02/06/2023 10:42:07 AM


Document Has Been Signed on 02/06/2023 10:42 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 CARE IIIFACILITY NUMBER:
342701192
ADMINISTRATOR:LABELLA, MARKFACILITY TYPE:
740
ADDRESS:6700 SUN RIVER DRTELEPHONE:
(916) 490-0237
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:14CENSUS: 0DATE:
02/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mark Labella and Penina TuimaualugaTIME COMPLETED:
11:00 AM
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Licensing Program Analysts (LPA) Avelina Martinez and Albert Johnson and Licensing arrived announced to conducted a 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 were 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
  • Repair exposed wires through the facility
  • Open plastic cover to clear for fire escape route
  • Electric cover plate in storage area by rooms 7/8/9 and remove debris.
  • Remove Dead bolt from fire escape exterior door


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-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
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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