BELLA NOVA VILLA II

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of 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 observation the Licensee did not comply with the section cited above in that cameras in the common areas have an audio component which poses a potential personal rights risk to persons in care.

Official plan of correction

The Administrator unplug the cameras during today's visit, and cameras will remain disconected until they can confirm that the cameras do not record audio and will submit a statement detailing if cameras have or do not have an audio system. by 06/06/25.

Deadline recorded: Jun 6, 2025. 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 observation, the licensee did not comply with the section cited above in three sinks where the water tempearature measured over 130 degrees F which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/07/2024 Plan of Correction The administrator agrees to adjust the water temperature and submit proof and log for five (5) days of the water temperature within the required temperatures of 105F-120F.

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 two rooms that had furniture and a other items blocking the exits which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/06/2024 Plan of Correction POC has been met. Staff removed all items blocking the room exits leading outside.

Official classification

Type A

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(e) 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: 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 as a family member was observed to be going through residents medication files, helping a staff with their duties, and had access to the residents medication files and medication which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/07/2024 Plan of Correction Administrator agrees to write a letter of understanding of regulation 87355 in its entirety and agree to not have any individual work at the facility without being finger printed cleared and associated to the facility.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(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 medication audit, the licensee did not comply with the section cited above as the LPA observed more meication tablets than the resident should have based on the quantityh and start day which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/07/2024 Plan of Correction Administrator agrees to submit a plan on how they will ensure the health and safety of the residents in regards to their medication intake, which should include staff medication training and submit to CCL by 9/7/24, and submit proof of staff training by 9/13/24.

Official classification

Type B

Official code

87307(d)(5)

Regulation authority

CCR

What the official deficiency says

(5) Night lights shall be maintained in hallways and passages to nonprivate bathrooms. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as the hallway ligh leading to a non private restroom was inoperable which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/16/2024 Plan of Correction Administrator agrees to fix the lighting in the hallway and submit proof to CCL by 09/16/24.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 three staff that did not have 1staid/CPR training on file which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/16/2024 Plan of Correction Administrator agrees to have all three staff obtain 1st aid/CPR training and submit proof by 09/16/24.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: 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 as the administrator's file was missing and additional stall records which poses a potential health and safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/20/2024 Plan of Correction Upon observation the Administrator stated that files had been stolen. Administrator agrees to conduct a staff file audit and ensure all files are current and complete. In addition the administrator will submit a incident report, and file a police report to report the theft. Everything should be submitted to CCL by 9/20/24.

Official classification

Type B

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 record review, the licensee did not comply with the section cited above as one staff had a health screening that belong to a different staff with their name whited out and new staff name written on top 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 Administrator agrees to have staff obtain a new health screeing from their physician and submit to CCL by 9/16/24.

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, the licensee did not comply with the section cited above in four staff that did not have annual required training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/23/2024 Plan of Correction Administrator agrees to have all staff obtained their required annual staff training and submit proof to CCL by 9/23/24.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. 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 one resident who did not have a TB test results in their file 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 Adminsitrator agrees to have resident obtained TB test result from their physician and submit proof to CCL by 9/6/24.

Official classification

Type A

Official code

87705(f)(1)

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: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Based on LPA's observation, the licensee did not comply with the section cited above as kitchen knife was observed in an unlocked kitchen drawer which poses an immediate health, safety and personal rights risk to persons in care.

Official plan of correction

Staff placed knife in a locked kitchen drawer during facility visit. Administrator will contract an outside vendor to provide training. Admin will provide documentation of staff inservice regarding regulation 87705(f)(1) to CCL by 11/23/2022.

Deadline recorded: Nov 18, 2022. A deadline is not proof that correction was completed.