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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206855
Report Date: 08/22/2023
Date Signed: 08/22/2023 06:01:10 PM


Document Has Been Signed on 08/22/2023 06:01 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:BELLA HOMEFACILITY NUMBER:
547206855
ADMINISTRATOR:FELIX, MARIA EVAFACILITY TYPE:
740
ADDRESS:403 N. RYAN TERRACETELEPHONE:
(559) 781-1508
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:6CENSUS: 4DATE:
08/22/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
03:56 PM
MET WITH:Maria E. FelixTIME COMPLETED:
06:32 PM
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LPA came back to the facility to complete the facility's annual inspection started on 8/21/23. LPA reviewed facility's records during the visit.

Through LPA’s observations, documentation review and interview with Licensee, the required infection control practices are found to be in compliance. There is no deficiency cited for this visit.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Les XiongTELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023
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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