BELLO GARDENS ASSISTED LIVING

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's & Administrator interview and record review, the licensee did not comply with the section cited above in 3 out of 6 residents (R2, R3, & R4) R2 & R4's reappraisals were from 2023 & R 3 did not have a Reappraisal, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2025 Plan of Correction Licensee/Administrator agrees to arrange a meeting with parties outlined in regulation 87463(a) and update appraisals for noted residents. Licensee will submit self certification that all appraisals have been updated per regulation 87463 by POC due date, 10/24/2025 to clear the citation.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA & Administrator's interview & record review, the licensee did not comply with the section cited above in 1 out of 6 resident files reviewed did not have a signed Admissions Agreement which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2025 Plan of Correction Administrator to submit signed Admission Agreement & Signed Personal Rights page to LPA/CCL by POC due date 10/24/2025 to clear citation.

Official classification

Type B

Official code

87470(a)(2)(A)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall ensure that infection control practices are maintained as follows: (2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows: (A) Surfaces such as floors, chairs, toilets, sinks, counters and tabletops shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary. These surfaces shall also be disinfected when these surfaces are contaminated and visibly soiled with blood or body fluids or other potentially infectious material. 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 ensuring that bathrooms and bedrooms were clean and sanitary. LPAs observed three quarter sized reddish brown feces smear marks on the floor under the toilet in one of the facility's communal bathrooms. Additionally, LPAs smelled urine in resident room where the floor felt sticky upon entry and a bedside commode was observed with urine in it. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2025 Plan of Correction DRP to submit self certification that facility has been brought into compliance and will remain in compliance with regulation moving forward to CCL by POC due date 1/17/2024.

Official classification

Type B

Official code

87307(c)

Regulation authority

CCR

What the official deficiency says

(c) Individual privacy shall be provided in all toilet, bath and shower areas. 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 one instance where a residents bedroom opened up onto a communal bathroom, which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/17/2025 Plan of Correction DRP to submit picture proof that the door between bedroom #11 and the connecting communal bathroom is permanently locked from both sides to maintain resident privacy and remain in compliance with residents personal rights to CCL by POC due 1/17/2024.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: 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 ensuring that facility has a complete and accurate record for all staff which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2025 Plan of Correction DRP to submit self certification that all records have been brought into compliance with regulation to CCL by POC due date 1/31/2025.

Official classification

Type B

Official code

1569.625(b)(1)

Regulation authority

HSC

What the official deficiency says

(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. 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 ensuring that all staff have the required initial training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2025 Plan of Correction DRP to submit proof of completion of all required initial training for staff to CCL by POC due date 1/31/2025.

Official classification

Type B

Official code

1569.69(a)(1)

Regulation authority

HSC

What the official deficiency says

(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (1) In facilities licensed to provide care for 16 or more persons, the employee shall complete 24 hours of initial training. This training shall consist of 16 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 8 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first four weeks of employment. 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 ensuring that all staff who assist residents with medication administration have proof of all the required initial medication administration training completed which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2025 Plan of Correction DRP to submit proof of completion of all required initial medication administration training for required staff to CCL by POC due date 1/31/2025.

Official classification

Type B

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. 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 at least three instances of observed expired food and several instances of unlabeled opened or unsealed food items throughout facility freezers and refrigerators which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2025 Plan of Correction DRP to submit self citification that all food has been inspected and facility has been brought into compliance with regulation. Additionally, DRP to submit proof of staff training reviewing proper food labeling and storage to CCL by POC due date 1/31/2025.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 ensuring that facility maintains proof of disaster drills completed which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/31/2025 Plan of Correction DRP to submit proof of a required quarterly disaster drill completed on each shift to CCL by POC due date 1/31/2025.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(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 LPAs observations, the Licensee did not comply with the section cited above. LPAs observed cleaning supplies , vitamins, razors, and toxins in residents' bathroom and paint on back patio that were unlocked and accessible to residents in care. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/20/2023 Plan of Correction Licensee to submit 1) Self-Certification stating that training will be conducted with facility staff, 2) an In-Service Training will be done reviewing Regulation Care of Persons with Dementia 87705(f)(2). Self Certification to be submitted to Community Care Licensing (CCL) by POC due date of 10/20/2023, and Training to be submitted by due date of 10/23/2023.

Official classification

Type B

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation and interview with S1 the licensee did not comply with the section cited above as facility had Lysol, comet, & rust remover stored with food supply (see pictures) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/23/2023 Plan of Correction Licensee agrees to ensure food items are stored separately from soaps, detergents and cleaning compounds. Licensee to submit written plan detailing how facility will keep food items stored away from other items and photo evidence the current food items are separated from soaps and cleaning compounds. Written plan to be submitted to CCL by POC date of 10/23/2023.

Official classification

Type B

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation the licensee did not comply with the section cited above, when LPA's entered facility, auditory alarm went off altough staff did not respond for the 5 minutes LPA's stood inside front door, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/23/2023 Plan of Correction Administrator to ensure that all exits are alarmed and operational at all times; ensuring the safety and well being of residents in care at all times.Administrator to submit plan of correction showing knowledge and understaning of regulation 87705 and facility procedures regarding 87705. Submit POC to Licensing by 10/23/23

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). 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 in that the water temperature tested in 6 out of 9 bathrooms accessible to residents was between 100.4 degrees F & 104.3 degrees F, this poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/23/2023 Plan of Correction Administragtor to submit a log of water temperature from 10/20/23 to 10/27/2023. Licensee to submit a written statement that they understand the regulation and will be in future compliance by POC due date 07/14/2023

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence - (b)...the licensee shall be responsible for the following: (3) Ensuring ...that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observations, Administrator did not ensure the regulation above due to Resident bedroom & downstairs facility bathroom having a strong foul odor of urine. This is a potential personal rights and health risk to residents in care.

Official plan of correction

POC Due Date: 10/23/2023 Plan of Correction Administrator to train all staff submit copies of staff training on regulation 87626(b)(3). Training to include the date, time, duration, subject, instructor, staff's name and signature. Training to be submitted to Community Care Licensing (CCL) by POC due date 10/23/2023

Official classification

Type B

Official code

87307(3)(c)

Regulation authority

CCR

What the official deficiency says

(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. (c) The use of common wash cloths and towels shall be prohibited. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation and interview with staff, the licensee did not comply with the section cited above when finding 3 hand and body towels in joint bathrooms and interview with staff who stated " towel is there in bathroom for all the people to use " which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/23/2023 Plan of Correction Licensee/Administrator to ensure all facility shared resident batthrooms have papertowels available for resident use as needed as common hand towels/any common towels are prohibited.Submit plan of correction and ensure compliance with the regulation in regards to paper towels in resident bathrooms for use as needed. .POC due 10/23/23.

Official classification

Type B

Official code

80087(a)

Regulation authority

CCR

What the official deficiency says

80087(a)Buildings and Grounds. The facility shall be kept clean, sanitary and in good repair at all times. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's & Administrator's observation during tour of facility , the licensee did not comply with the section cited above finding side door window shattered & taped together which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2023 Plan of Correction Licensee must maintain the facility clean, safe, sanitary, and in good repair at all times. Facility agrees to ensure that the entire facility will be clean and in good repair at all times. Facility to fix and/or replace broken stained glass window of door. Licensee to submit an LIC 9098 self-certification that facility is in good repair with picture to CCL by POC date of 10/31/2023 in order to clear the deficiency.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a) Personnel Requirements – General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… This requirement has not been met as evidenced by: Based on records reviewed and interviews conducted, facility staff did not respond to residents elopement in an appropriate amount of time and or follow facilities Plan of Operation by contacting Law Enforcement. Records reviewed indicated that resident was a wanderer w/ dementia, not allowed to leave facility unatended. Interviews stated R1 AWOLed for aprox 2 hrs before outside individual contacted 911. Facility protocol is to contact law enforcement within 30 min.This poses an immediate risk to the health and safety of residents in care.

Official plan of correction

Administrator to ensure that all staff are trained in dementia care-specifically elopement procedures and policy including response to auditory alarms and contacting Law Enforcement. Administrator agreed to provide scheduled dates for all staff trainings to CCL by POC due date.

Deadline recorded: Jan 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465(a)(1) Incidental Medical and Dental Care. The Licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of the residents. ***This requirement has not been met as evidenced by: Based on record review, statements, documents, and interviews, at Administrators request staff did not seek emergency medical attention immediately, R1 remained at facility 2 hours with a head wound needing 5 stitches. This posed an immediate risk to the health of R1.

Official plan of correction

Administration shall provide refresher training to all care staff regarding the requirements of 87465 and submit, by POC date, schedule and topic outline to CCL(1st due date12/23/22), with proof of training to follow within 2 weeks in order to clear the deficiency (final due date (1/4/2023).

Deadline recorded: Dec 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Based on LPA's observation of medicaiton and unlocked cabinet located in the kitchen, medications are accessible to residents in care. This is an immediate Health and Safety risk to residents in care.

Official plan of correction

Administrator agrees to submit self certification that all medications are locked and inaccessable to residents in care. Administrator agrees to submit POC to CCL by 11/07/2022. & Administrator agrees to submit staff training and signature sheet to CCL by POC 11/11/2022.

Deadline recorded: Nov 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Hot water temperature in 1 of facilities residents bathroom faucets messured 122.7 degrees F. falling out of Title 22 acceptable regulation of 105 degrees F. and 120 degrees F. Deficient Practice Statement Based on observation the licensee failed to maintain hot water temperature between 105 & 120 F in 1 of 6 resident's bathrooms which poses an immediate Health, Safety risk for residents in care. LPA toured the facility w/ administrator. and observed that 1 of the 6 hot water temperatures was 122.7 degrees F.

Official plan of correction

POC Due Date: 10/17/2022 Plan of Correction Licensee to ensure water temperature is maintained within regulation - 105 TO 120 degrees F. Administrator to submit pluming inspection from this weekend by EOB 10/17/2022. Facility to begin monitoring for the next 7 days. Admin to submit a 7 day log taken from the resident's bathrooms to CCL by 10/24/2022.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by :All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department Deficient Practice Statement Based on observation Administrator didn't comply w/section cited above in 1 out of 5 staff did not have the proper fingerprint clearance and was not associated.

Official plan of correction

POC Due Date: 10/17/2022 Plan of Correction Administrator agrees to send in written plan of correction that they understand all staff must be fingerprint cleared and associated prior to working in the facility. POC due date of 10/17/2022. Due to Administrators failute to have S1 fingerprint cleared and associated to the facility Civil Penalties are being issued today in the amount of $500.00.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on records obtained and interviews conducted, licensee did not comply by restricting ability of residents to exit, which poses an immediate health, safety or personal rights risk to persons in care. **Immediate Civil Penalty assessed in the amount of $500.

Official plan of correction

Administrator to send in written statement indicating that they understand regulation 87203 and will ensure future compliance -as proof of correction and removing towels & garbage bags from door handles by POC due date 8/3/2022. Additionally, facility will conduct an in-service for all staff regarding the regulation and submit signed & dated log for all staff to be submitted no later than 8/9/2022. **Immediate Civil Penalty assessed in the amount of $500.

Deadline recorded: Aug 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(6)

Regulation authority

CCR

What the official deficiency says

87468.1 (a)(6) Personal Rights of Residents in All Facilities (a) Residents in all RCFE shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement was not met as evidenced by: Based on LPA record review & interviews R1 & residents, movements were restricted to the facility. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

Administrator to ensure residents personal rights are maintained. Administrator agrees to review 87468.1 (a)(6) & provide a written plan that addresses how the facility will ensure the rights of resident to move freely at the facility by POC date 8/3/22. Licensee agrees to obtain training from an outside source for all staff on the topic of residents’ personal rights and to ensure that residents needs are being met, sign in log with dates and name of training to be submitted by 8/9/22.

Deadline recorded: Aug 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement was not met by: LPA observed that the exit door to the front of the facility had the auditory high and low alarms were turned off.This is an immediate Health and Safety Risk to residents in care.

Official plan of correction

Administrator to ensure that all exits are alarmed and operational at all times; ensuring the safety and well being of residents in care at all times.Administrator to submit plan of correction showing knowledge and understaning of regulation 87705 and facility procedures regarding 87705. Submit POC to Licensing by 5/5/22.

Deadline recorded: May 5, 2022. A deadline is not proof that correction was completed.