Bella Vita Assisted Living

Type of visit: Prelicensing

Licensing Program Analyst (LPA) De Leon conducted an announced Pre-Licensing Change in Ownership visit to the facility above. LPA met with Applicant Abiy Tesfazgy and explained the purpose of the visit. LPA conducted a tour with Applicant of the physical plant both inside and outside. Infection Control: The facility has sign in and out binders with hand sanitizer at entry. The facility has a 30 day supply of Personal Protective Equipment (PPE). Cleaning and Disinfection will be completed by staff on an ongoing bases. Staff will be trained upon hiring and annually thereafter on infection control and PPE usage. Physical Plant/Environmental Safety: The facility has a carbon monoxide and smoke detectors present in the common areas of the facility they are battery back up, hard wired with a sprinkler system. All resident bedrooms have smoke detectors. The facility is clean, safe, sanitary and in good repair. All windows and screen are in good repair throughout the facility. All out door and indoor passageways are clear and no obstructions were observed. The facility is a 4 bedroom, 2 bathroom home with a living room, dining room, kitchen, laundry room, storage closets and a 3 car garage. Disinfectants, cleaning solutions and laundry products are locked in laundry room cupboards and garage. Medications are stored in a locked cupboards in the kitchen. The lighting and lamps through out the facility are for safety and for resident comfort. Faucets delivering the hot water was tested and measured at degrees F. The resident bedrooms have beds, dressers, closet space, lighting, and lamps. Mattress are in good conditions and the facility has plenty of clean linens. The facility has hallway lighting that is kept on during the evenings and nights for resident safety. The front yard and back yards are large with plenty of space for resident use. The outside area has a patio with furniture and shade for residents comfort. Continued 809-C Operation Requirements: The facility is currently licensed for a capacity of 6 and currently occupies 4 residents in care. The applicant has submitted for a capacity of 6 with a plan of operation and admission agreement. The fire clearance is approved for 6 Non-Ambulatory residents. Applicant is pending for a hospice waiver for 6. Personal Records/Training: All confidential forms and files for staff are stored in a locked garage. Training records are kept on file. Client Records/Incident Reports: The residents files are kept confidential and stored in locked garage. Incident report are completed by Licensee/Administrator. Applicant will send incident reports to CCL when required. Food Service: The kitchen is clean, safe and sanitary. The facility is kept free of flies, insects and rodents. The freezer is kept at 0 degrees and refrigerator is kept at 40 degrees. The facility currently has 7 days of Non-perishable and 2 day of perishables as well as emergency food and water. Items that can pose danger such as sharps and knives are locked in the kitchen drawer. Cleaning items are stored and locked separately then food supply. Health Related Services: The facility has a first aid kit with manual and all supplies stored in the laundry room cupboards. Centrally stored medication was and will be stored and locked in kitchen cupboards. Disaster Preparedness: The current disaster plan is posted in the common area of the facility and meets all requirement using the LIC 610D form. Applicant has submitted an new LIC 610D, LPA has reviewed and plan, Administrator will provide updated plan to LPA.. The facility sketch shows all emergency exits. The facility conducts training and quarterly disaster drills covering different scenarios. The facility has plenty of flashlights and batteries for emergencies. The facility has back up food and water supply for emergencies. Comp III was waived. The facility is currently set up for Dementia residents, locks are placed on all sharps, cleaning and laundry products, the gate on side of house if self closing and self latching, and exiting door alarms are installed on all doors leading to the outside. Pre-Licensing is complete and this facility has no deficiencies Exit interview conducted and copy of report printed for Applicant.the state’s words, verbatim · CDSS document, Aug 12, 2026