Bellahomecare II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Robert Campbell arrived at the facility unannounced to conduct the Required Annual Inspection, met with Mary Joy Sison - Lead Caregiver and spoke with the Cherry Cook - Administrator over the phone. The facility file review was conducted in the Regional Office and additional forms were requested and reviewed on site. The facility is licensed for six (6) Elderly Adults. LPA toured the facility along with Mary Joy Sison - Lead Caregiver, and made observations pertaining to the one year required annual. The facility was inspected inside and outside, there were no obstructions or debris to the indoor or outdoor passageways currently. The facility is a two-story home, six (6) bedrooms, five (5) bathrooms. Physical Plant: The facility phone number is (760) 975-3161 and is currently operable. LPA observed all six (6) residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA inspected the five (5) facility bathrooms, and the hot water temperature tested was not within regulations (145 degrees Fahrenheit). Type A deficiency will be issued on LIC809D. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers (01/26/2026). LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights." The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care currently at the time of this visit. LPA observed window broken (picture taken) with glass still in it in front of dining table. Type A deficiency will be issued on LIC809D. (Continued to 809-C) Continued... Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. The medications were not observed to be pre-filled during this inspection, and the Fire and/or Disaster Drills were logged and conducted quarterly (6/10/2026). The overall facility is clean, the furniture is in good condition. The facility cooling system and other appliances were operable currently at the time of this visit, and there were safety lights for night throughout the facility, along with a first aid kit and manual. LPA observed no ladder for emergency exiting on the second floor according to facility sketch stating one is required. Type A deficiency is cited on LIC809D. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. Food shopping for groceries once a week or as needed. Care & Supervision: Facility has sufficient staff, two (2) staff on site at the time of this visit for the current residents in care. Administrator - Cherry Cook certificate is renewed with an expiration date of 9/07/2028. Records Review: The LPA reviewed five (5) residents, four (4) staff files all required documentation was reviewed and complete. There were three Type A deficiencies under Title 22, Division 6 Regulation violations observed and cited during today’s visit on LIC809D. An exit interview was conducted, and a copy of this report was discussed and proved to May Joy Sison -Lead Caregiver.the state’s words, verbatim · CDSS document, Sep 28, 2026

Type of visit: Case Management - Deficiencies

On 2/3/2026, Licensing Program Analyst (LPA) Valerie Flores And Abdoulaye Zerbo conducted an unannounced visit to the facility for the purpose of following up on complaint 18-AS-20260201223909. LPA met with Administrator Cherry Cook and explained the purpose of the visit. During the visit for the complaint, LPA's observed insulin injections to be stored in the refrigerator and was easily made accessible to residents. LPA's observed bread to be stored in the freezer outside of a container or any packaging. Through interviews, it was reported that Staff #2 (S2) are administering Resident #2 (R2) insulin injections. Through interviews, it was reported that snacks are only provided once a day during the afternoon. Therefore, deficiencies will be issued in accordance to California Code of Regulations Title 22 Division 6. An exit interview was conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Feb 3, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87629(b)(1) · Plan of correction due date: Feb 3, 2026

(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection... or has it administered by an appropriately skilled professional. This requirement was not met with evidence by (2) two out of (2) two staff reported that Staff #1 (S1), who is not a licensed professional, administers Resident #2 (R2) insulin injection.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Licensee will inform PACE that Resident #2 is requiring assistance with insulin injections. Licensee will provided proof of communication to LPA by Close of Business confirming that PACE is responsible for managing the insulin injection.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87555(2)(h) · Plan of correction due date: Feb 3, 2026

(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. (h) The following requirements shall apply to medications which are centrally stored:the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Licensee immediately purchased and place insulin injection in a lock box. POC was fulfilled.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(3) · Plan of correction due date: Feb 17, 2026

(b) The following food service requirements shall apply: (3) Between-meal nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician. This was not met with evidence by; Staff interviews reported that residents are provide one snack a day.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: An outservice training will be conducted with staff regarding general food requirements. This shall be provoided to LPA by close of business of 2/17/2026 via email.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(23) · Plan of correction due date: Feb 17, 2026

(b) The following food service requirements shall apply: (23)All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This was not met with evidence by: food was observed to be stored without a container or original packaging.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: An outservice training will be conducted with staff regarding general food requirements. This shall be provoided to LPA by close of business of 2/17/2026 via email.

Type of visit: Required - 1 Year

On 9/11/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced 1-year required annual visit. LPA met with Care staff, Juliana Castro, and explained the purpose of the visit. LPA conducted a tour of the facility with Juliana. During today's visit, LPA Flores observed the following: The physical plant is a two story structure. The facility consisted of (5) five resident bedrooms, (1) staff bedroom, (4) four bathrooms, living room, formal dining area, laundry room, great room, and kitchen. Residents bedrooms were equipped with the required bedding, furniture, seating, and functional lighting. Additional linen and towels are available for residents and appear to be in good repair. The kitchen area was kept clean and free of litter, rodent, and insects. LPA Flores observed a planned activities calendar for the month of September posted on the refrigerator door. This facility has a pool which is locked at all times with fencing that is more than 5 ft. high around the perimeter of the pool. The facility met the (2) two-day supply of perishable food and (7) seven-day supply of non-perishable items. Per Care Staff, Juliana Castro, there are no firearms and/or ammunition on the premises. Indoor/outdoor passageways were free of obstructions. LPA observed a fully charged fire extinguisher mounted in the kitchen. Dual smoke and carbon monoxide detectors were deem fully operable. LPA observed knives and other sharp instruments locked in a cabinet located in the kitchen. Centrally stored medication was placed in a locked cabinet near the entryway. Water temperature measured at 108.3-degree Fahrenheit meeting within the department's requirements. (Continue to LIC809C...) (Continuation from LIC809) Emergency disaster plan, facility sketch, See Something Say Something, LTCO poster, facility License, and Infection Control plan were posted on a walls throughout the facility. Facility staff records review include but are not limited to criminal record clearance, health screenings, and First-aid/CPR training, and relevant training's to provide Assistance with Activities of Daily Living (ADL's). Resident records included but not limited to updated physician reports, pre-appraisals, appraisals, Needs and Services plan, and Functional Capabilities. Medication was reviewed and LPA did not observe any discrepancies. No deficiencies were cited during today's visit. An exit interview was conducted with Juliana and a copy of this report was provided to Administrator, Cherry Cook.the state’s words, verbatim · CDSS document, Sep 11, 2025

Allegation investigated: Staff neglected resident while in care Staff do not provide a safe and healthful environment Staff do not provide assistance with dressing and grooming

Licensing Program Analyst, (LPA) Kathleen Banrasavong, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Administrator, Cherry Cook over the phone and Caregiver, Arden Valdobino, where the LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observations, interviews with staff members and residents, and a review of records. On September 18, 2024, Community Care Licensing received a complaint alleging that staff neglected resident while in care, staff do not provide a safe and healthful environment, and staff do not provide assistance with dressing and grooming. It was reported that when R1 calls for staff, staff do not come to assist R1. LPA interviewed Administrator who stated that the residents all have a call light button to request for assistance and staff are available to assist. Unfounded Administrator also stated that the facility does laundry daily for R1. Administrator admitted that R1 did wear the same clothes twice in one week, but indicated the clothes were washed. LPA conducted interviews with staff members, who indicated they do assist R1 with grooming, dressing, and laundering. Information obtained from interview with R1 stated that they provide assistance in showers twice a week, grooming and dressing daily. Information obtained from interviews with additional pertinent parties corroborated the information provided. During the facility tour, LPA observed clean clothes in R1’s closet and dressers and LPA reviewed shower logs for residents. LPA requested and obtained shower logs for the past two months. No concerns were observed. Based on the information obtained during the investigation, this agency has investigated the complaint that staff neglected resident while in care, staff do not provide a safe and healthful environment, and staff do not provide assistance with dressing and grooming. We have found that the complaint was unfounded, meaning that the allegations are false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was discussed with and provided to Administrator, Cherry Cook over the phone and signed by Caregiver, Arden Valdobino. Administrator indicated the facility is well staffed and there are no concerns regarding the level of care being provided. Information obtained from staff members stated that they attend to the resident in a reasonable amount of time when they are called. Information obtained from interview with R1 stated that the staff members take a while but did not provide a specific a time frame. LPA interviewed additional pertinent parties, who revealed that there was no issue in regards to waiting for an unreasonable time for assistance. During the LPA’s visit, the LPA verified that R1’s call light was operational. It was also alleged that facility staff were not providing a safe and healthful environment. It was alleged that there was a snake in R1’s room. Administrator stated the facility does not have any animals at the facility. Administrator denied observing or being notified about a snake in R1’s room. Administrator also denied that the facility has an issue with reptiles. Information obtained from an interview with R1 stated R1 saw a long, skinny object moving in the corner of the room. During tour of the facility, LPA observed the facility inside and out, and did not observe a snake. Information obtained from interviews with additional witnesses revealed no issues or concerns regarding snakes in the facility. In regards to the allegation that staff do not provide assistance with dressing and grooming, it was reported that the facility did not shower or groom R1. It was reported that R1 was sent to an outing in the same clothes that R1 wore earlier in the week. Administrator stated that the facility has shower logs and the facility provides assistance with daily grooming and dressing.the state’s words, verbatim · CDSS document, Dec 12, 2024 · control 18-AS-20240918161101

Allegation investigated: Staff hit resident Staff verbally abuse resident Staff finacially abuse resident

Licensing Program Analyst, (LPA) Kathleen Banrasavong, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Caregiver, Arden Valdobino and had the Administrator, Cherry Cook, on the phone, where the LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observations, interviews with staff members and residents, and a review of records. On November 20, 2024, Community Care Licensing received a complaint alleging that the staff hit Resident 1 (R1). It was alleged that R1 was hit with towels. The allegation did not mention a specific staff member. Information obtained from interview with Administrator and staff denied the allegation and stated that there have been no advisements of residents hit by staff member with a towel. Information obtained from interview with R1 stated that staff members at the facility did not hit R1 with towels. Information obtained from additional witnesses stated that R1 had made prior allegations about a facility he was living at prior to becoming a resident at this facility. No issues or concerns about being physically abused by staff were reported. Unfounded It was also alleged that the facility staff were verbally abusing R1 by saying inappropriate comments about R1’s deceased mother. During the investigation, information obtained from interview with Administrator indicated that the staff do not verbally abuse residents. Administrator stated that staff are aware of resident’s personal rights and are required to treat all residents with respect. Information obtained from interview with R1 stated that staff did not make comments about their deceased mother. R1 stated that staff do not speak to them inappropriately. LPA conducted interviews with staff members, who denied they made inappropriate comments regarding R1’s deceased mother. Information obtained from interviews with all pertinent parties corroborated the information. Regarding the allegation that the facility was financially abusing R1, it was reported that the facility staff was stealing money from R1. Information obtained stated that R1 has a payee, who handles all of R1’s finances. Administrator corroborated the information and further stated that the facility does not have access to R1's. Information obtained from interview with R1 denied that staff members are financially abusing them due to them having a payee who handles their finances. Information obtained from interviews with additional parties revealed no issues or concerns regarding financial abuse. Based on the information obtained during the investigation, this agency has investigated the complaint alleging that staff hit the resident, verbally abused the resident, and financially abused the resident. We have found that the complaint was unfounded, meaning that the allegations are false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was discussed with and provided to Administrator, Cherry Cook over the phone and signed by Caregiver, Arden Valdobino.the state’s words, verbatim · CDSS document, Dec 12, 2024 · control 18-AS-20241120123301

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that six (6) residents live at this facility. However, there was four (4) residents present at the time of the inspection. There was two (2) staff members present. The Administrator, Cherry Cook was advised of the annual and came to conduct and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Six (6) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Cherry Cook, Administrator’s certificate expiration date was 09/07/2024. The Department of Social Services received her renewal package on 08/12/2024. Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 75 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the laundry room. There is a locked location for storing laundry soap, cleaning supplies and chemicals in the closet in the garage. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is two (2) secured fireplaces at this facility. There is one (1) secured pool at the facility. There is one (1) secured gate that has a self-latching lock located in the front of the house. LPA observed emergency supplies and one (1) first aid kit. The last emergency fire drill was conducted on 09/04/2024. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed that they were dispensed accurately. Pursuant to Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to Administrator, Cherry Cook.the state’s words, verbatim · CDSS document, Sep 17, 2024