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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604790
Report Date: 03/18/2024
Date Signed: 03/18/2024 10:48:49 AM

Document Has Been Signed on 03/18/2024 10:48 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:BELLAHOMECARE IFACILITY NUMBER:
374604790
ADMINISTRATOR:COOK, CHERRYFACILITY TYPE:
740
ADDRESS:629 GUAVA AVETELEPHONE:
(406) 998-8022
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 6CENSUS: 0DATE:
03/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Cherry CookTIME COMPLETED:
10:57 AM
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Licensing Program Analyst (LPA) Ramon Serrano, conducted an announced Pre-Licensing inspection. LPA met with Licensee Cherry Cook and we discussed the purpose of the visit.

LPA conducted a tour of the facility, both inside and outside. There are no pools on site. The smoke and carbon monoxide alarms were present. Toilets intended for client use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, curtains and paint throughout the facility, was observed in good condition. Each room intended for resident use had the appropriate furniture, bedding and appropriate lighting. Licensee Cherry Cook stated there are no firearms stored on the premises.

Hot water temperature was measured in the facility at 120 degrees F. The ambient temperature inside the facility was measured at 69 degrees F. The facility was observed to be clean and kempt with no strong malodors. The refrigerator and freezer was observed to be clean and operational, with an ample amount of food to meet client needs.

Pre-Licensing is complete and this facility has no deficiencies. An exit interview was conducted with Cherry Cook and a copy of this report along with Licensee Rights was provided to Cherry Cook whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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