BELMARE SENIOR LIVING

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:There was a bottle of cleaner found in Resident’s (R1) refrigerator. This poses an immediate health and safety risk to residents in care.

Official plan of correction

On 4/17/2026 the facility had training Hazardous Materials.

Deadline recorded: Jul 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411

Regulation authority

CCR

What the official deficiency says

Personnel Requirements (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. The requirement is not met as evidenced by Based on interviews with staff and reviewed March 2026 schedule licensee did not ensure basic needs were being met by staff. This poses an immediate health and safety risk to residents in care.

Official plan of correction

The facility will continue to hire staff

Deadline recorded: Jul 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

87208(a) Plan of Operation (a) The licensee shall have and maintain a current, written definitive plan of operation…The licensee shall operate the facility in accordance with the terms specified in the plan… This requirement is not met as evidenced by: Based on interview & record review, staff did not follow facility’s Plan of Ops re: that caregivers receive training in proper handling of meds, that meds be centrally stored along w/ its record, that a physician order be on file, which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

The Licenseee will discipline the staff involved in the improper administration of the narcotic; The Licensee will provide training for all Med Techs regarding administration of narcotics,and the procedures for handling medication without orders and for obtaining the needed orders.

Deadline recorded: Oct 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 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 is not met as evidenced by: Based on interviews with residents and staff, records review, and observations made, the Memory Care facility has less than the 1:7 ratio the Administrator said is needed to meet the residents' needs.This poses an immediate risk to residents in care.

Official plan of correction

Administrator refused to partipate in developing plan of correction. The licensee will provide to the Department their plan to meet the regulation by the POC date

Deadline recorded: Oct 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(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 is not met as evidenced by: Based on observation, record review, and interview, the licensee did not ensure that that resident did not have a full length bedrail with a doctors order, which prohibited the resident from movely freely off of their bed. This poses an immediate health, safety, and personal rights risks to persons in care.

Official plan of correction

Administrator was unable to collorborate with the LPA to arrange Plan of Correction.

Deadline recorded: Sep 4, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents...(a) Residents shall have…the...rights (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers... This requirement is not met as evidenced by: Based on interview with R6 and R7, incident reports of 12 unwitnessed falls with four serious injuries, and staff schedule review, adequte care and supervision is not being met. This poses an immediate risk to residents in care.

Official plan of correction

Administrator refused to participate in developing a plan of correction. The licensee will provide to the Department their plan to meet the regulation by the POC date

Deadline recorded: Oct 3, 2025. A deadline is not proof that correction was completed.

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...(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on review of medication administration records, R1 did not receive all required daily medications, This poses an immeidate risk to residents in care.

Official plan of correction

Administrator refused to participate in developing plan of correction. The licensee will provide to the Department their plan to meet the regulation by the POC date

Deadline recorded: Sep 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision... This requirement is not met as evidenced by: Based on an interview with S7, the expected staff response time to call buttons is ten minutes. Review of pendant logs show that 29% of call buttons are answered in more than ten minutes. This poses an immediate risk to residents in care.

Official plan of correction

Administrator refused to participate in developing plan of correction. The licensee will provide to the Department their plan to meet the regulation by the POC date The licensee will provide to the Department their plan to meet the regulation by the POC date

Deadline recorded: Oct 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(1)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b)The following...shall apply: (1) Where all food is provided by the facility arrangements shall be made so that each resident has available at least three meals per day. The requirement is not met as evidenced by: Based on interviews with F1 and S5 and review of R1's LIC602, modifications were made to R1’s diet that were not required by the doctor, and that when not sufficiently staffed, R2 missed his meal. This poses an immediate risk to residents in care.

Official plan of correction

Administrator refused to participate in developing plan of correction. The licensee will provide to the Department their plan to meet the regulation by the POC date.

Deadline recorded: Sep 11, 2025. A deadline is not proof that correction was completed.

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...(3) Ensuring that incontinent residents are kept clean and dry... This requirement is not met as evidenced by: Based on interview with F1, R1 was found on 8/4/25 with soaked briefs and bedpads. According to R1's LIC 602, resident is not ambulatory and requires assistance for toileting needs.This poses a potential risk to residents in care.

Official plan of correction

Administrator refused to participate in developing plan of correction. The licensee will provide to the Department their plan to meet the regulation by the POC date.

Deadline recorded: Oct 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(a)(1)

Regulation authority

CCR

What the official deficiency says

87468 Personal Rights (a) Residents…shall have…the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced. by: Based on a review of S9’s disciplinary records and interviews with F1, S10, and S12, which showed that S9 did not treat residents in care with dignity by using curse words when speaking to them. This poses a potential risk to residents in care.

Official plan of correction

Administrator refused to participate in developing plan of correction. The licensee will provide to the Department their plan to meet the regulation by the POC date

Deadline recorded: Sep 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465(g) Incidental Medical and Dental Care The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health...This requirement was not met as evidence by. Based on file review and interviews, The Licensee did not ensure to seek timely medical attention for R1. R1 was not provided timely medical attention due to stating that R1 had the option of refusal of medical services. However, based on facility records staff are to call 911 if they R1 was not at their level of consciousness. This posed an immediate health and safety risk to R1.

Official plan of correction

A statement of correction and acknowledgement shall be provided to the LPA by POC date 12/31/2024.

Deadline recorded: Dec 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

(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 of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.This requirement was not met as evidenced by: Based on file review and interview, The licensee did not ensure that facility reported R1's falls that occured on 06/18/2024 and 07/26/2024 were reported to the department. LPA reviewed facility records and found that there were no reported incidents regarding falls or R1 within the months of March 2024-August 2024. This poses an immediate health,safety and personal rights risks to persons in care.

Official plan of correction

A statement of correction and acknowledgement shall be provided to the LPA by POC date 12/31/2024.

Deadline recorded: Dec 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...This requirement was not met as evidenced by: This requirement was not met based on staff and family interviews as well as incident reports sent to the Department. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to submit a plan to the Department outlining what measures will be taken to ensure resident needs are being met.

Deadline recorded: Dec 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: Occurrences...which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours ... This requirement was not met as evidenced by LPA Jensen's verification that the Department and responsible parties were not notified with 24 hours. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Licensee agrees to submit a signed attestation that CCR 87211 has been read, understood and will be complied with in it's entirety.

Deadline recorded: Dec 27, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)(13)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (13) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or the services he needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Jensen's record review, a resident with diabetes did not have the required documentationto reflect this condition. As such LPA Jensen was unable to determine oif the resident is able to handle their own injections and glucose testing which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/07/2024 Plan of Correction The licensee will update all resident records needed to reflect R1's diabetes. A new physician report will be emailed to teh LPA by POC due date.

Official classification

Type B

Official code

87705(c)(5)(A)

Regulation authority

CCR

What the official deficiency says

(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. (A) When any medical assessment, appraisal, or observation indicates that the resident's dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA Jensen's resdient record review 2 of 5 residents did not have a current physician's report which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/28/2024 Plan of Correction The Licensee will ensure all residents have a current LIC 602 and will email the LPA once complete.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care ....The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interviews conducted and records reviewed facility staff did not order refills of a resident's medication in a timely manner.

Official plan of correction

The Licensee will email a plan to LPA Jensen for auditing medication administration and taking action as appropriate based on audit findings within 24 hours.

Deadline recorded: Sep 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87564(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic Services Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on interviews conducted with staff, residents and LPA Jensen's observation of unsanitary conditions in a resident room, R1 was not receiving the care needed. This poses an immediate risk to the health, safety and personal rights or residents in care. b

Official plan of correction

The Executive Director has agreed to seek a higher level of care for R1 as of this day. The facility is also setting up the call signal system to notify the Wellness Director and Executive Director when signals are not responded to promptly starting 4/15/24.

Deadline recorded: Apr 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - General Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met based on: LPA Pascua's review of 7 staff files, 7 of 7 files were missing first aid certificates or had expired first aid certificates. This poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Director agrees to send an attestation to maja.jensen@dss.ca.gov that all staff will be enrolled in and complete first aid training by 01/15/24.

Deadline recorded: Dec 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

Resident Records The licensee shall ensure that a separate, complete, and current record is maintained for each resident...This requirement was not met as evidenced by: Based on LPA Pascua's resident record review 11 out of 12 resident records were incomplete to a varying degree-please refer to LIC 809C for specifics. This poses an immediate risk to the health, safety and personal rights of reisdents in care.

Official plan of correction

The Director agrees to send an attestation to maja.jensen@dss.ca.gov that all resident records will be updated and complete by 01/15/24

Deadline recorded: Dec 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs....This requirement was not met as evidenced by: Based on interviews conducted and the signal system response time report, staff took more than ten minutes to respond to the signal system 44% of the time during the course of a randomly selected 10 day period. This poses a potential risk to the health, safety and personal rights of residents in care.

Official plan of correction

The Health and Wellness Director agrees to conduct an in-service training and weekly audits for one month. Proof of completion of the plan of correction will be emailed to maja.jensen@dss.ca.gov by the due date.

Deadline recorded: Nov 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic Services Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on the incident report provided and the interview conducted with the Health and Wellness director, R1 left the facility without the knowledge of staff which poses an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The facility moved the resident to memory care the following day and scheduled an appointment for a new LIC 602. No additional plan of correction is required at this time.

Deadline recorded: Sep 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) ... Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need ... maintained in the resident’s record. The licensing agency may require... The facility failed to meet the above requirement as evidenced by: The facility did not include a doctor's note in R1's file indicating the need for a postural support.

Official plan of correction

Licensee has immediately posted a sign on the wheelchair that the seatbelt is not to be used as it is against regulations. If physician's note is provided, then sign will be removed.

Deadline recorded: Sep 28, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed...(9) The licensee shall ensure that infection control practices are maintained in the facility... The facility failed to meet the above requirement as evidenced by: The facility required residents and staff to provide skin-scraping tests as evidence that they had scabies when their own policy stated that it was not necessary.

Official plan of correction

Licensee has agreed to provide an attestation to kimberly.viarella@dss.ca.gov that in the future it will adhere to its own infection control plans and policies. This will be comleted by the close of business on 09/22/2023.

Deadline recorded: Sep 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... The facility failed to meet this requirement as evidenced by: This LPA observed that 2 out of 3 resident beds either had soiled mattress protectors or were missing sheets and only had a mattress protector. One room was also malodorous.

Official plan of correction

Licensee shall increase the number of housekeeping hours designated to Memory Care by an additional 12 hours per week and will also supply sheets when needed. Licensee will submit a template of scheduled hours to kimberly.viarella@dss.ca.gov by 09/28/2023.

Deadline recorded: Sep 28, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). The Licensee did not comply with the section above when: Based on observation this LPA observed a 5 inch pair of scissors in an unlocked drawer in a memory care resident's open room.

Official plan of correction

Licensee conducted an in-service the same day the violation was observed. Licensee shall submit a sign-in sheet to kimberly.viarella@dss.ca.gov by 09/08/23 from that in-service.

Deadline recorded: Sep 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(B)(2)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia (b) In addition to the requirements as specified...(2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. The Licensee failed to comply with the above regulation when: Based on observation, this LPA observed 10 toxic hygiene items amongst 3 open resident rooms. These items included but were not limited to: Pantene shampoo and conditioner, Jergens Hydrating Coconut moisturizer, Neutragena shower gel, and CalProtect ointment.

Official plan of correction

Licensee shall have MedTechs do sweepsfor restricted/toxic items in Memory Cre resident rooms on a daily basis. Licensee will submit schedule of sweeps to kimberly.viarela@dss.ca.gov by 09/08/23.

Deadline recorded: Sep 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.312(d)

Regulation authority

HSC

What the official deficiency says

HSC - 1569.312(d) Basic services requirements: Every facility required to be licensed under this chapter shall provide at least the following basic services:...(d) Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement is not met as evidence by: Based on incident report, the facility did not comply with section cited above in 1569.312(d). R1 AWOL'D from facility. The LIC 602 states the resident was not allowed to leave the facility unassisted. This presents an immediate health and safety risk to the resident in care.

Official plan of correction

Licensee agrees to conduct an in-service training with staff to go over what and how staff shall ensure that residents do not AWOL. A statement of correction will be submitted by plan of correction date of 09/08/23 via email to LPA Kim Viarella. Proof of staff training for the cited section will be completed and a signature sheet of all staff who attended will be submitted to LPA Kim Viarella after training is finished.

Deadline recorded: Sep 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements (a) Each licensee shall furnish... reports as the Department may require... (2) Occurrences, such as ... safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This regulation was not met when the Department did not receive a fax or phone call to the LPA/Worker of the Day with the details of the altercation. An SOC 341 should also have been completed for cross reporting purposes.

Official plan of correction

The Licensee shall conduct a training on reporting requirements and submit an outline of the training and a participant signature sheet to kimberly.viarella@dss.ca.gov by 09/20/2023.

Deadline recorded: Sep 20, 2023. 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

(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 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on the observation of a water temperature measurement of 125 degrees, made by the LPA, the the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/08/2023 Plan of Correction The water temperature was lowered while LPAs were still on the premises. No further POC required.

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 the observation of the LPAs, the licensee did not comply with this regulation and cleaning solutions were found in areas accessible to the residents which posed an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/08/2023 Plan of Correction Cleaning solutions were removed and stored immediately and no longer pose a hazard or risk to residents. No furhter POC required.