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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701140
Report Date: 04/13/2022
Date Signed: 04/13/2022 09:35:53 AM

Document Has Been Signed on 04/13/2022 09:35 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:BELLA HILLS CARE HOMEFACILITY NUMBER:
342701140
ADMINISTRATOR:TIEN, LIT A.FACILITY TYPE:
740
ADDRESS:8579 TRAYNOR WAYTELEPHONE:
(916) 687-1207
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 4CENSUS: 0DATE:
04/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:House Manager, Christopher SinonTIME COMPLETED:
10:00 AM
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On 4/13/22 at 9:00am Licensing Program Analyst (LPA) Kevin Gould arrived at Bella Hills Care Home for the purpose of conducting a follow up pre-licensing inspection and ensure the facility is ready to be licensed. LPA met with House manager, Christopher Sinon and together conducted a tour of the home. The facility is a single story home located in a residential neighborhood. The home is equipped with four (4) bedrooms, two (2) bathrooms, kitchen, living room, dining room, family room and laundry room. The house is also equipped with an attached two car garage.

LPA observed outdoor seating and patio furniture for residents to utilize the back yard that meets regulations. LPA observed all trash cans in the bathrooms equipped with lids and were step-opening trash cans. LPA observed the fencing on the right side of the home has been repaired and no longer poses a potential danger to future residents. LPA inspected first aid kit and observed all required items including tweezers.

Based on the inspection and observations during the pre licensing inspection, LPA has no objections or concerns regarding the facility being licensed. LPA Gould will submit application for approval with Centralized Application Bureau (CAB)

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022
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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