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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701207
Report Date: 01/22/2025
Date Signed: 01/23/2025 10:16:06 AM

Document Has Been Signed on 01/23/2025 10:16 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BELMARE SENIOR LIVINGFACILITY NUMBER:
502701207
ADMINISTRATOR/
DIRECTOR:		CINDY LICHTENHANFACILITY TYPE:
740
ADDRESS:1450 WEST F STREETTELEPHONE:
(209) 764-3164
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY: 72CENSUS: DATE:
01/22/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Lacy Vincent TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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 A virtual informal conference -  office meeting was held via Microsoft Teams to discuss compliance issues presented throughout the last 12 months. Present in today's meeting was Licensing Program Analyst (LPA) Arielle Pascua, Licensing Program Manager (LPM) Lisa Rios, and Facility Designated Administrator (FDA), Lacy Vincent.

The following topics were discussed during the informal conference:
  • Waivers and Exceptions
  • Hospice
  • Staffing


The facility will do the following to achieve compliance:
  • Continue to provide care and supervision to the residents within allotted hospice waiver allowance
  • Facility will provide the department a request for hospice increase
  • Facility will follow up on capacity changes and provide new fire clearance
The regional office will do the following:
  • Continue to collaborate and provide assistance to licensee as needed


Per California Code of Regulations (CCR) - Title 22 - no deficiencies are being cited. An exit interview was held, and a copy of the report was sent via email.


Licensee to send a signed copy to LPA Pascua.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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