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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206855
Report Date: 08/10/2022
Date Signed: 08/10/2022 12:55:46 PM

Document Has Been Signed on 08/10/2022 12:55 PM - 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:
08/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:Maria Eva FelixTIME COMPLETED:
01:34 PM
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On 08/10/22, Licensing Program Analysts (LPAs) M. Medina and B. Miranda arrived to conduct an unannounced Annual Required Infection Control Inspection. LPAs allowed entrance by Licensee, Maria Eva Felix Administrator Certificate #6023955740, expires 3/21/2023. Front door is facility main entrance/exit. LPA's observed visitor sign-in, thermometer, and hand sanitizer at entrance. LPA's were screened for COVID upon entry. Staff observed to be wearing masks while working.

Facility toured and observed to be clean and odor free. All common areas have adequate seating and lighting available for residents in care. Resident bedrooms toured. Facility has 2 shared bedrooms with adequate spacing between beds, and 2 private bedrooms. Resident bathrooms toured, grab bars and non-skid mats observed. Bathroom is stocked with hand soap and paper towels. Kitchen toured, all sharps are locked and secured and inaccessible to residents. Facility has 2-day supply of perishable and 7-day supply of non-perishable food available. Medication observed to be locked and secured in hallway closet. Chemicals are locked and secured in laundry room. Fire extinguisher is current. Smoke detectors and carbon monoxide detectors observed operational.

Outside of facility toured. Pool is surrounded by fence and is locked and secured and inaccessible.

Licensee to submit copies of Administrator Certificate, First Aid Card, LIC 500 (Personnel Report), LIC 610E (Emergency Disaster Plan).

No deficiencies cited during inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2022
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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