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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206855
Report Date: 08/19/2021
Date Signed: 08/19/2021 11:48:25 AM

Document Has Been Signed on 08/19/2021 11:48 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:BELLA HOMEFACILITY NUMBER:
547206855
ADMINISTRATOR:FELIX, MARIA EVAFACILITY TYPE:
740
ADDRESS:403 N. RYAN TERRACETELEPHONE:
(559) 781-1508
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 6DATE:
08/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Maria Eva FelixTIME COMPLETED:
11:54 AM
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Licensing Program Analyst (LPA) M. Medina arrived unannounced to conduct an Annual
Required - Infection Control. LPA met with Licensee Maria Eva Felix and stated the purpose of the visit. Facility has one central entry and exit. Upon entry to the facility, LPA observed visitor log-in/temperature check. Facility staff observed to be wearing facial coverings. Residents wear facial coverings while out in the community.

Facility tour was conducted with Licensee. All entrances, exits, and pathways were free from obstructions. No fire clearance issues observed during today's inspection. LPA observed signs at the entrance promoting social distancing, cough/sneeze etiquette, and hand-washing. LPA observed reminders to wash hands in facility bathrooms. All bedrooms are private. Bathrooms were stocked with paper towels and liquid soap. Trash cans observed to have lid.

LPA observed a 30 day supply of medications. Medications are locked and inaccessible to residents in care. Food supply checked. LPA observed a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. Facility has a 30 day supply of cleaning supplies and PPE.

Fire exits free of obstruction. Fire extinguisher present with a service date of 08/09/21. Smoke detector and carbon monoxide tested and observed operational during inspection.

No deficiencies observed during this inspection.

Exit interview conducted with Administrator. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Facility Licensee signature on file.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2021
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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