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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209416
Report Date: 06/03/2024
Date Signed: 06/03/2024 09:16:45 AM

Document Has Been Signed on 06/03/2024 09:16 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:BELLA CARE HOME LLC FRENCH VILLAFACILITY NUMBER:
107209416
ADMINISTRATOR/
DIRECTOR:		GONZALES, PHILLIPFACILITY TYPE:
740
ADDRESS:67 W EL PASO AVE.TELEPHONE:
(559) 259-6228
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 0DATE:
06/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Licensee 1 (L1) Marilen GonzalesTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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On 06/03/24, Licensing Program Analysts (LPA) M. Yang conducted an announced Pre-licensing /
Component III Inspection. LPA introduced self, stated the purpose of the visit and was allowed entry into
the facility. LPA met with Licensee 1 (L1) Marilen Gonzales and staff Joanna “Ann” Lorio.

The facility is a 6 bedroom, and 3 bathroom home and fire clearance were granted for 6 non-Ambulatory for a total capacity of 6. LPA toured the facility with L1. There are no residents present during this inspection. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. Medications will be locked and inaccessible to resident in the kitchen cabinet. First aid kit was observed and contained all required items. Kitchen was toured and observed to have dishes, plates, and utensils. Knives will be kept locked in kitchen drawer. Refrigerator temperature maintained at 40 degrees F and freezer maintained at 0 degree F. Adequate non-perishable and perishable food supplies observed. A fire extinguisher was observed and had a service date of 01/29/24. LPA observed an extra supply of bed linens, towels, and personal hygiene products. Bedrooms were observed to have the required furnishing and are ready for occupancy. Mattresses and box springs were in good condition. Hot water temperature ranged between 108.4 and 113.5 degrees F in bathroom, 107.7 degrees F in bathroom 2, and between 119.4 and 118.3 degrees in shared bathroom. Bathroom observed to be operational. Outside of facility toured. LPA observed adequate outdoor seatings available for residents. Smoke detectors and carbon monoxide were observed to be operational during this inspection. LPA observed side gate to be self-latching and free debris.

Component III was conducted during today's pre-licensing visit.

I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to
CAB in Sacramento for final review prior to license being issued.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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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