BELLA VISTA

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. -This requirement is not met as evidenced by: -Based on record review, the licensee did not comply with the section when R1 has 1 remaining tablet for 1 of the medications which does not match what should have left based on the recorded start date on LIC622 which poses a potential health and/or personal rights risks to person in care.

Official plan of correction

Administrator to do the following and submit POC by 3/25/26: 1. Review the record and submit corrected LIC622. 2. In-service the staff and submit copy of in-service training,

Deadline recorded: Mar 25, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in saline solution, chest rub and nail polish remover in residents' rooms, and shovels and rakes in Bldg B's yardvwhich pose an immediate health, safety and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 11/05/2025 Plan of Correction Staff locked all the items. In addition, administrator to in-service the staff and submit copy of training topics with attendees signatures by 11/05/25.

Official classification

Type A

Official code

87565(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (c)(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in not having some of the R2's medications and not administering the dosage for 1 of the medications listed on the After Visit Summary which pose an immediate health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 11/05/2025 Plan of Correction Administrator stated she'll obtain the current doctor's order. In addition, administrator to discontinue the administration of medication(s) no longer on the current order and obtain those listed which facility does not have. Proof to be submitted by 11/05/25.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence ......... -This is requirement is not met as evidenced by: -Based on records review and interview, the licensee did not comply with the section above for not sending report for R1 for fall incidents and alleged abuse.

Official plan of correction

Corrected. Administrator provided the incident reports while LPA was at the facility.

Deadline recorded: Oct 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(c)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements: (c) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours as required...... --This is requirement is not met as evidenced by: -Based on records review and interview, the licensee did not comply with the section above for not sending the SOC341 while posed a potential safety and personal rights risks to person in care.

Official plan of correction

Corrected. Administrator provided copy of SOC341 while LPA was at the facility.

Deadline recorded: Oct 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in greasy cooking range and grease deposits in corner of flooring in the kitchen in Bldg A which pose a potential health, safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Corrected. Staff cleaned the range and kitchen floor.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in following which pose a potential health, safety and/or personal rights risks to persons in care: vinyl flooring tiles in Bldg B coming off; mildew in the shower and broken faucet in Bldg B; chipped electrical outlet plate in one of the resident's rooms in Bldg A.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Administrator have the shower cleaned, and faucet and electrical outlet replaced. Administrator to have the tiles replaced and submit pictures by 11/07/24:

Official classification

Type B

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section when staff crossed-out one of resident's (R2) medications on the label which poses a potential health and/or personal rights risks to persons in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Administrator to in-service the staff and submit proof by 11/07/24.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in not having LIC622 for resident's (R1) medications filled on 10/02/24 & 10/21/24] which poses a potential health and/or personal rights risk to person in care.

Official plan of correction

POC Due Date: 11/07/2024 Plan of Correction Corrected. Administrator completed the LIC622.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in R1 having doctor's order for Ferrous Sulfate but facility does not have this medication which poses an immediate health risk to persons in care.

Official plan of correction

POC Due Date: 10/25/2024 Plan of Correction Administrator to check with the doctor and obtain the medication if still needed; otherwise, obtain discontinued order. Proof to be submitted by 10/25/24.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not comply with the section cited above for S3 not having the reqjuired training which poses a potential health, safety and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/24/2023 Plan of Correction Administrator stated she'll have the staff trained. Proof to be submitted by 11/24/23.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above for S3 not having first aid training which poses a potential health and/or safety risks to persons in care.

Official plan of correction

POC Due Date: 11/24/2023 Plan of Correction Administrator to have the staff trained and submit copy of certificate by 11/24/23.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above for staff medications in unlocked which poses an immediate health and/or safety risks to persons in care.

Official plan of correction

POC Due Date: 11/11/2023 Plan of Correction Staff locked the room. In addition, administrator to in-service the staff and submit copy of training topic with attendees signatures by 11/11/23.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (c) The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section cited above. Four residents appraisals are over a year old which pose potentiial health and/or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2023 Plan of Correction Administrator stated she'll do the re-sppraisals and submit self-certification by 8/02/23.

Official classification

Type B

Official code

8888

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. R4's LIC602A and reappraisal are over a year old. The LIC602A also indicated R4 is dependent on all ADLs; however, R4 can feed self. These pose potential health and/or personal rights risk to person

Official plan of correction

POC Due Date: 08/02/2023 Plan of Correction Administrator to set-up an appointment and have the LIC602A and appraisal updated. Proof to be submitted by 8/02/23.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence ......... -This is requirement is not met as evidenced by: -Based on records review and interview, the licensee did not comply with the section above for not sending report for R1 when R1 AWOLed.

Official plan of correction

Administrator to read the Regulations and stated in the future she will submit an incident report as needed and in timely manner. Self-certification to be submitted by 7/25/23.

Deadline recorded: Jul 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

87457 Pre-Admission Appraisal - General (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission with the admission criteria.... -This is requirement is not met as evidenced by: -Based on records review and interview, the licensee did not comply with the section above for not completing Pre-Admission Appraisal for R1 and R2,

Official plan of correction

Administrator to complete the Pre-Admission Appraisals, and submit copies by 7/25/23.

Deadline recorded: Jul 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(b)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (b) The licensee shall immediately bring any such changes to the attention of the resident's physician and his family or responsible person. -This requirement is not met as evidenced by: - Based on records review and interview, the licensee did not comply with the section above for not bringing the changes and/or observation of R1 and R2's behaviors to the primary care phycian (pcp) and psychiatrist.

Official plan of correction

Administrator stated she will reach out to the resident's care team to set-up an appoitnment with residents' psychiatrist and pcp and will complete re-appraisals by 7/25/23.

Deadline recorded: Jul 25, 2023. A deadline is not proof that correction was completed.