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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803536
Report Date: 09/02/2020
Date Signed: 09/16/2020 08:28:34 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:BELLA VISTA VILLAGEFACILITY NUMBER:
496803536
ADMINISTRATOR:VEGVARY, JULIUS & MERCEDESFACILITY TYPE:
740
ADDRESS:18941 SONOMA HWYTELEPHONE:
(707) 483-0998
CITY:SONOMASTATE: CAZIP CODE:
95476
CAPACITY:12CENSUS: 9DATE:
09/02/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Mercedes Vegvary, LicenseeTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Mota made contact on this date, virtually by Facetime, with Mercedes Vegvary for the purpose of a case management visit. LPA conducted a virtual inspection via Facetime. It is being conducted by Facetime due to COVID - 19 precautions. There are currently 9 residents in care, none of which are on hospice and some who have a diagnosis of dementia.

During today's inspection, LPA and Licensee toured the facility virtually. LPA observed staff wearing masks. LPA observed signs posted throughout the complex outside regarding no visitors, hand sanitation and signs/symptoms of COVID. LPA and Licensee toured the kitchen area where staff and residents are screened. COVID postings were observed. Screening includes temperatures being taken along with a questionnaire that is completed of possible symptoms. Hand sanitizer is not placed in residents rooms due to dementia diagnosis. Each room does have access to a sink area where hand washing is encouraged routinely per Licensee.

Licensee stated visitor's are being asked to visit residents via Facetime. If family does visit, the visit takes place outside through a gate with at least 6 foot distancing and all parties wear a mask.

LPA provided PIN 20-23 to Licensee regarding surveillance testing of staff. LPA discussed with Licensee the importance of speaking with staff regarding activities that they are involved in outside of the facility, ie: family gatherings, etc.

LPA discussed disaster preparedness with Licensee who states all emergency drills and staff training are up to date. The facility has a dedicated van that residents can be evacuated in with all staff having access to the keys.

Continued on 809-C
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Kimberley MotaTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: BELLA VISTA VILLAGE
FACILITY NUMBER: 496803536
VISIT DATE: 09/02/2020
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Prior to today's tele-visit, Licensee had spoken with the Sonoma County Department of Health in regards to disaster preparedness and was provided the following link: https://socoemergency.org/emergency/evacuation-centers/


LPA and Licensee discussed the need to have residents files up to date, including needs and service plans.



No deficiencies were cited at today's virtual tele-visit.
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Kimberley MotaTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2020
LIC809 (FAS) - (06/04)
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