<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209190
Report Date: 03/18/2025
Date Signed: 03/18/2025 11:31:33 AM

Document Has Been Signed on 03/18/2025 11:31 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:BELLA CARE HOME LLC-FARMHOUSEFACILITY NUMBER:
107209190
ADMINISTRATOR/
DIRECTOR:
GONZALES, PHILLIPFACILITY TYPE:
740
ADDRESS:1131 FARMHOUSE AVE.TELEPHONE:
(559) 259-6228
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY: 6CENSUS: 5DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Administrator - Marilen GonzalesTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/18/2025, Licensing Program Analyst (LPA) M Vega arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility. Administrator (AD) Marilen Gonzales was notified of Licensing visit over the phone and arrived shortly to attend the visit. LPA toured the facility with staff 2 and AD.

The facility was observed to be at a comfortable temperature, of 72 degrees F. Facility is free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. LPA observed most residents in common area after breakfast watching television. Department phone number and infection prevention information signs were posted thought the facility.

Inspecting kitchen LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. An emergency disaster supply was observed.

A fire extinguisher was observed with a service date of 01/25/2025. All residents’ bedrooms were observed to be at comfortable temperatures. The bathroom’s water temperature was tested and recorded reading of 112.2 degree F.

Cleaning supplies were observed to be in a locked in closet in the hallway area. Medications observed to be locked in a cabinet in the kitchen area. LPA reviewed medication records accurate at the time of inspection. An outdoor seating area was observed operational for residents in care. No exterior obstructions and fire exit operational. Facility has no exterior bodies of water.

LPA reviewed staff and residents’ files. No deficiencies were observed and cited.

Exit interview conducted. A report was signed, and a copy of this report was provided for facility records.

Permission granted from Administrator for Administrator Assistant to sign document.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1