BELLA GARDENS

Official classification

Type B

Official code

87208(a)(1-6)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (1) Statement of purposes and program goals. (2) A copy of the Admission Agreement, containing basic and optional services. (3) Statement of admission policies and procedures regarding acceptance of persons for services. (4) Administrative organization. (5) Staffing plan, qualifications and duties. (6) Plan for training staff, as required by Health and Safety Code sections 1569.625, 1569.626, and 1569.69 and as specified in Section 87411, Personnel Requirements–General and Section 87705, Care of Persons with Dementia. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation interview and record review, the licensee did not comply with the section. LPA identified (5) resident rooms had surveillance cameras in each resident room. The facilty does not have this included in the Plan of Operation. This is violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction Licensee will comply with Title 22, Section 87208 (a)(1-6) and submit an updated Plan of Operation that includes the use of surveillance cameras in resident rooms. Additionally, the Licensee will submit a waiver for the use of surveillance cameras in residents' private rooms, along with a corresponding Plan of Operation. Proof of correction must be sent to attn: LPA Ernand Dabuet by fax 424-544-1016 by 07/31/26.

Official classification

Type A

Official code

87705(f)(1-2)

Regulation authority

CCR

What the official deficiency says

(f) Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements: (1) Licensees shall notify the licensing agency of their intention to lock exterior doors and/or perimeter fence gates. (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or perimeter fence gates and that facility staff on all shifts have access to, and know how to use, equipment needed to unlock exterior doors or perimeter fence gates. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above. LPA identified one side exterior gate with a pad lock. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/12/2026 Plan of Correction Licensee will comply with Title 22 87705(f)(1-2) regulations. LIcensee will ensure that exterior gates do not have padlocks as as safety obstructions in case of emergency exits. Licensee will remove the padlock or request for fire inspection approval for the local fire department. Proof of correction must be sent to LPA Dabuet by 07/12/26. *Correction was completed during the visit.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. 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 screen located in doorway of bedroom number three (3) shall be re-screened in order to prevent any insects from entering the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2023 Plan of Correction LPA and Administrator have agreed that the screen shall be repaired within the next seven (7) days and that media evidence (photo/scan) will be submitted via email (mario.leon@dss.ca.gov) on, or prior to, the POC due date which is 07/10/23.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) licensee shall furnish to the licensing agency such reports as the Department... (1) A written report shall be submitted to the licensing agency... within seven days..(A) Death of any resident from any cause regardless of where the death occurred... This requirement is not met as evidence by: Based on interview with licensee, Licensee failed to report incident with resident R1 admitted to hospital for change of health condition. This violation possesses a potential Health and Safety risk to residents in care.

Official plan of correction

Licensee will adhere to the regulations and will ensure any changes in resident's health condition or death will be reported to CCLD. Licensee will ensure to provide proof of correction sent by fax 323-981.1781 to El Segundo Regional office by 08/19/22

Deadline recorded: Aug 19, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(b)

Regulation authority

CCR

What the official deficiency says

87405(b)(2) Administrator - Qualifications and Duties. (b)The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. (2 )Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: Based on interview and record reviews the Licensee/Administrator failed to adhere to Title 22 regulations, resulting to multiple deficiencies cited, which poses a potential health and safety risk to residents in care.

Official plan of correction

The licensee will create a plan to ensure that the administrator performs knowledge of and conforms to applicable laws, rules and regulations. Plan of correction will be submitted by POC due date: 08/12/22

Deadline recorded: Aug 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87632(2)

Regulation authority

CCR

What the official deficiency says

87632 Hospice Care Waiver (2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services... This requirement is not met as evidence by: Based on interview with licensee, Licensee failed to report to CCL with resident R2 admitted at this facility as of 6/14/22. This violation possess a potential Health and Safety risk to residents in care.

Official plan of correction

Licensee will adhere to Title 22 87632 regulations and will ensure notify CCL of hospice residents in care. Licensee will ensure to provide proof of correction sent by fax 323-981.1781 to El Segundo Regional office by 08/12/22.

Deadline recorded: Aug 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(B)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidence by: Based on interview with administrator, Licensee failed to show proof for full bed rails for (R4) who is not a hospice reisdent. This violation possess a potential Health and Safety risk to residents in care.

Official plan of correction

Licensee will adhere to the regulations 87608 and will remove full bed rails for R4. Licensee will ensure to provide proof of correction sent by fax 323-981.1781 to El Segundo Regional office by 08/12/22. *This citation was corrected during visit 08/01/22.*

Deadline recorded: Aug 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(3)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (3) Fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all direct care staff. This requirement is not met as evidence by: Based on records review with the administrator, Licensee failed to show proof quarterly fire and eaarthquake drills are conducted. This violation possess a potential Health and Safety risk to residents in care.

Official plan of correction

Licensee will adhere to the regulations 87705 and will conduct a fire/earthquake drill as required. Licensee will ensure to provide proof of correction sent by fax 323-981.1781 to El Segundo Regional office by 08/12/22.

Deadline recorded: Aug 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. Resident #3 (R3) identified on hospice and admitted 06/14/22. The facility is only approved for (2) hospice waiver and is now operating with (3) hospice residents beyond the conditions and limitations specified on the license. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2022 Plan of Correction Licensee agrees to hospice waiver increase request to CCLD by correction date 08/08/22 understands that it is their responsibility to follow up on waiver requests and hospice residents should not reside at the facility until a hospice waiver is granted by CCL.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 [3] out of [3] [(disefectant solution, buther knife and sharp scissors) identified accessible to residents with dementia. The violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/01/2022 Plan of Correction Licensee will adhere to Title 22 Regulations 87309(a) and ensure that all hazardous items i.e. disenfectants, knifes and scissors are stored in locked cabinets and not accessible to residents in care. The violation will due on POC 08/01/22. *This vioation was corrected during visit on 07/30/22.*