BELLA CAI CARE HOME

Official classification

Type A

Official code

87628(b)(3)

Regulation authority

CCR

What the official deficiency says

87628(b)(3) Ensuring that syringes and needles are disposed of as specified in Section 87303(f)(2) 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 by having lose needle without disposed properly which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2025 Plan of Correction The Licensee stated they will disposed all needles properly and provided an in-service training to all staff.

Official classification

Type A

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

87465(c)(3) A record of each dose is maintained in the resident's record. The record shall include the date and the time the PRN medication was taken, the dosage taken, and the resident's response. 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 by not documenting PRN medication properly for 4 out of the 5 residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2025 Plan of Correction The Licensee stated they will create a PRN log in and conduct an service training for all staff.

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. 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 5 out of the 5 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2025 Plan of Correction The licensee stated they send proof of residents pre-admission and send copies to LPA Rico.

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 record review, the licensee did not comply with the section cited above by not having reappraisals for all 5 out of the 5 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/17/2025 Plan of Correction The Licensee stated they will send proof to LPA Rico of resident's pre-admission.

Official classification

Type A

Official code

87468(a)(20)

Regulation authority

CCR

What the official deficiency says

To be protected from involuntary transfers, discharges, and evictions.. state.. and relocation protections for residents. For purposes of this paragraph.. means a transfer, discharge, or eviction that is initiated by the licensee, not by the resident This requirement wasn't met as evidenced by: Based on interviews,and facility tour, the Administrator did not follow the proper relocaton the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator stated they will read the regulation cited 87468.2(A)(20) and will send a self-verification letter they have read and understood the regulation. POC due date by 7/21/2025

Deadline recorded: Jul 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87216(a)

Regulation authority

CCR

What the official deficiency says

87216(a) Bonding Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. This requirement wasn't met as evidenced by: Based on record review the Licensee did not have a surety bond which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator stated they will read the regulation cited 87216(a) and will send a self-verification letter they have read and understood the regulation. POC due date 7/21/2025

Deadline recorded: Jul 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87217(g)(1)

Regulation authority

CCR

What the official deficiency says

87217(g)(1)Safeguards for Resident Cash, Personal Property, and Valuables Records of residents' cash resources maintained as a drawing account shall include a ledger accounting... for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current. This requirement wasn't met as evidenced by: Based on record review the Licensee did not have a copy of R1 ledger account which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The Administrator stated they will read the regulation cited 87217(g)(1) and will send a self-verification letter they have read and understood the regulation. POC due date by 7/21/2025

Deadline recorded: Jul 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 cited above by not ensuring that staff 4 (S4) complete the required health screening report which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2024 Plan of Correction Licensee submitted proof of S4 completed health screening report which was obtained during the visit today, 9/10/2024. Plan of correction (POC) cleared.

Official classification

Type A

Official code

87412(a)(12)

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: (12) Hazardous health conditions documents as specified in Section 87411, Personnel Requirements - General. 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 cited above by not ensuring that Staff 4 (S4) complete the required tubeculosis (TB) test which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2024 Plan of Correction Licensee submitted proof of S4 completed TB test result which was obtained during the visit today, 9/10/2024. Plan of correction (POC) cleared.

Official classification

Type A

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(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 observation, interview, and record review, the licensee did not comply with the section cited above by not ensuring that staff 2 (S2) and staff 3 (S3) have the required first aid training from a agency such as Red Cross which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2024 Plan of Correction Licensee stated to submit S2 and S3 proof of first aid training to LPA Serrano on plan of correction (POC) due date.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (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, interview and record review, the licensee did not comply with the section cited above by not ensuring that resident 1 (R1) and resident 3 (R3) medications were given per their physicians directions as evidenced of resident 1 (R1) four (4) medications were not given per R1 physicians order. Also, LPAs observed resident 3 (R3) one (1) medication was not given per R3 physicians order. Moreover, LPAs observed R3 one (1) medication was not refilled on time, thus not given per R3's physician order, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2024 Plan of Correction Licensee stated to train all staff on CCR 87465(c)(2) and submit proof of staff training log to LPA Serrano on POC due date. Licensee conducted the required training during the visit today, 9/10/2024. POC cleared.

Official classification

Type A

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. 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 cited above by not ensuring that resident 3 (R3) has completed physician report /medical assessment on R3 file as evidence of R3's physician report does not have the required physician signature date which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2024 Plan of Correction LIcensee stated to submit a copy of R3 completed physician report/appointment to complete with the required physician signature date to LPA Serrano on plan of correction (POC) due date.

Official classification

Type B

Official code

87506(b)(17)(A)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (A) Section 87457, Pre-Admission Appraisal; 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 cited above by not completing the required pre-admission appraisal for resident 1 (R1) and resident 3 (R3) which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/16/2024 Plan of Correction Licensee submitted the statement of understanding on CCR 87506(b)(17)(A). POC cleared.

Official classification

Type B

Official code

1569.695(a)(2)

Regulation authority

HSC

What the official deficiency says

(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage. 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 cited above by not ensuring that the facility has the emergency supply kits, emergency food and water as required which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/16/2024 Plan of Correction Licensee stated to obtain/purchase emergency supply kits and emergency food and water and submit proof to LPA Serrano on the POC due date.

Official classification

Type B

Official code

1569.695(e)(2)

Regulation authority

HSC

What the official deficiency says

(e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident. 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 cited above by not completing the required needs and services plan for resident 1 (R1), resident 2 (R2) and resident 3 (R3) which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/16/2024 Plan of Correction Licensee submitted the required the required needs and assessment plan for R2 and R3 during the visit. POC cleared.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 cited above by allowing that resident 2 (R2) and resident 3 (R3) to have half bed rails without obtaing a written order from their physician indicating the need for half bed rail for mobility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/16/2024 Plan of Correction Licensee stated to obtain the required wirtten order form R2 and R3 physicain indicating the need for the half bed rail for mobility and submit proof to LPA Serrano on POC due date.