Bellerose Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Staff Carlette Montoya and Staff Whelwyn Surl. LPA stated the purpose of the visit. Staff informed ADM Lori Corral of the visit and ADM arrived at the facility at approximately 10:20AM LPA toured the interior and exterior of the facility with Staff Odalys Rodriguez and Staff Carlette Montoya to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the refrigerator temperature at 40 Fand Freezer at 0 F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. The facility fire system was last inspected by third party agency on 9/25/2025 and passed inspection. Fire extinguishers were last serviced on 9/24/2025. The facility emergency drill log was reviewed. The facility's last drill was conducted on 4/3/2026. ADM stated the facility will conduct a fire drill this week and submit documentation of the fire drill to Community Care Licensing Division (CCLD) by 9/18/2026. A Technical Assistance is being issued, see LIC9102 for more information. Page 1 of 2 LPA toured 8 resident bedrooms. All 8 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPA toured 5 resident bathrooms. All 5 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature with a range of 105.2 F to 109.4 F. LPA reviewed 4 resident records. LPA reviewed 4 resident’s Centrally Stored Medication and Destruction Records (CSMDRs). On 3 out of 4 CSMDRs, LPA observed staff did not document 1 medication for Resident R1, 1 medication for Resident R2, and 1 Medication for Resident R3. LPA also observed staff had written down incorrect dates filled for medications. Staff updated the dates filled for the medications on the CSMDR during the inspection. A Technical Assistance was issued, see LIC9102 for more information. LPA reviewed 4 staff records. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Administrator Lori Corral and a signed copy of this report was provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Sep 15, 2026

Allegation investigated: Staff did not prevent resident from being sexually assaulted. Staff left resident in soiled diapers for an extended period of time. Staff are not meeting resident's hygiene needs. Staff are not meeting resident's clothing needs.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation findings and met with Administrator (ADM) Lori Corral. On 11/05/2025, the Department received a complaint with the above 4 allegations. On 11/06/2025, the Department conducted an initial investigation visit. On 01/09/2026, LPA conducted an investigation visit. LPA interviewed ADM, 4 staff, and 3 residents. Continue on LIC9099-C. Page 1 of 4. Unfounded Staff did not prevent resident from being sexually assaulted: On 01/09/2026, LPA interviewed Administrator (ADM) Lori Corral. ADM stated the resident R1's family member FM1 has not been at the facility for over one year. ADM stated police officers came to the facility to investigate on 11/05/2025 and did not have a police case number. ADM stated APS (Adult Protection Service ) staff came to the facility to investigate on 11/06/2025 and the case was closed. ADM stated the facility never left any resident in the facility parking. ADM stated R1 was never put in the parking lot alone. ADM stated he/she did not receive any report that R1 was being sexually assaulted. On 11/06/2025, R1's POA told LPA on the phone that R1 lives at the facility for 8 years and never has any issue with the facility or with any facility staff. R1's POA stated the allegation is not true. Staff left resident in soiled diapers for an extended period of time: On 01/09/2026, LPA interviewed ADM. ADM stated each shift caregivers checked/changed residents' diapers at least 2 times within a shift and help resident for toileting. LPA interviewed 3 caregivers who work either at AM shift or PM shift. 3 Out of 3 caregivers stated they check/change residents' diapers at least 2 times and as needed in each shift. LPA interviewed 3 residents (R1, R2, R3). 2 Out of 3 residents stated the facility staff change their diapers around 3 hours and 1 Out of 3 residents stated the staff change the diaper in a timely manner. 3 Out of 3 residents stated they have no complaint against the facility. On 11/06/2025, R1's POA told LPA that R1 lives in the facility for over 8 years and never has any issues. R1's POA stated the allegation is not true. Continue on LIC9099-C. Page 2 of 4. Staff are not meeting resident's hygiene need: On 01/09/2026, LPA interviewed ADM. ADM stated the facility provides haircut and styling service to residents every 6 to 8 weeks. ADM stated the facility staff help residents for teeth brushing at least two times, one in the morning and one before bedtime. LPA interviewed 2 staff (S1, S2) who work in the AM shift. Both stated they help residents brushing teeth two times in their shift, one after residents wake up, and one after lunch. Both stated around every two months the facility provides hair cut service to residents. On 01/09/2026, during the interview with R1, LPA observed resident R1's hair was well-groomed and R1's overall appearance looked neat. On 11/06/2025, R1's POA talked to LPA on the phone and stated the allegation is not true. R1 does not have any issue in the facility. Staff are not meeting resident's clothing needs: On 01/09/2026, LPA interviewed ADM. ADM stated residents are changed to pajamas before going to bed and are changed to daily clothes when getting up. ADM stated if residents' clothes do not fit, the facility notifies families to provide new clothes for the residents. ADM stated that the facility did not find R1 has any issue of clothes that do not fit. LPA interviewed 2 staff (S1, S2). Both stated they did not find R1's clothes do not fit R1. On 01/09/2026, during the interview with R1, LPA observed R1's clothes were not tied, the clothes were fit for R1. On 11/06/2025, R1's POA talked to LPA on the phone and stated the allegation is not true. R1 does not have any issue in the facility. Continue on LIC9099-C. Page 3 of 4. Based on the statement made by resident R1's POA on 11/06/2025, all the 4 accusations/allegations are not true, R1 has been living at the facility for 8 years, and has not had any problem with staff or with the facility. The Department has investigated the above allegations. Based on the investigation, record reviewed, and interviews conducted, the Department found that the above allegations are UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citation noted today. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Feb 26, 2026 · control 26-AS-20251105160018

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual required 1 - year inspection. LPA met with Administrator (ADM) Lori Corral. LPA toured the facility inside and out with ADM to include the kitchen, hallways, 15 resident bedrooms, 2 restrooms, 1 shower room, storage closets, dining room, activity room, laundry room, medication room, and exterior. License, ADM certificate, and personal rights posters were observed in the facility. Exit routes were free and clear of obstruction. Exit doors equipped with door alarms. Facility temperature maintained at 77 degrees F. Kitchen observed with a lock on the door. 7 days worth of non perishables and 2 days worth of perishable foods were observed sufficient. Cleaning solutions and food supplies observed in separate locations. Fire extinguishers last serviced on 09/18/2024. ADM stated service guys were scheduled to come on 9/24/25 at 9:00AM. LPA reviewed the facility fire alarm system inspection report dated 4/11/2025. The inspection report stated the facility fire alarm system is fine. Hot water temperature maintained between at 119 degrees F. Flash lights, first aid box were observed in the facility. The last time the faculty conducted the emergency frill was on 8/20/2025. LPA reviewed 5 resident files and 5 staff files. No citation noted today. Exit interview was conducted with ADM. The report was provided to ADM for review. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Sep 23, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual required 1 - year inspection. LPA met with Administrator (ADM), Lori Corral. During visit, LPA toured the facility with ADM to include the kitchen, hallways, resident bedrooms, bathroom, shower room, storage closets, laundry room, medication room, and exterior. Fire exit routes were free and clear of obstruction. Exit doors equipped with operable door alarms. Facility staff present are fingerprint cleared and associated to the facility. Facility temperature maintained at 76 degrees F. Activities calendar posted outside of the activity room. Residents observed participating in activities to include movies, exercise, and live entertainment during visit. Kitchen observed with a lock on the door. Facility has at least 7 days worth of perishables and 2 days worth of non-perishable foods. Items inside the refrigerator observed covered and labeled. Refrigerator temperature maintained at 42 degrees F. Freezer temperature maintained at -3.5 degrees F. Cleaning solutions and food supplies observed in separate locations. Fire extinguishers last serviced on 09/01/2023 and 04/19/2024. Administrator states the fire inspector will be coming soon to service the extinguishers dated 09/01/2023. Facility has a carbon monoxide detector present. LPA and ADM entered into 4 resident bedrooms (#4, 9, 12, and 16). Resident bedrooms equipped with beds, linens, dressers, lidded trash bins, and adequate lighting. Sliding and screen doors are in working condition with no items obstructing the exit way. Showers observed with grab bars. Hot water temperature maintained between 116 - 118 degrees F. See LIC809-C. LPA reviewed 4 resident files were complete to include an updated physician's report, needs and services plan, identification and emergency contact information, admission agreement, consent forms, personal rights forms, and safeguard of personal properties and valuables. 4 resident's beds are equipped with half rails and obtains a physician's order for the half bed rails. During the tour of the resident bedrooms, LPA observed hygiene items in 4 resident bedrooms. Based on record review of the resident's physician's report, 4 residents are not at risk if allowed access to hygiene items. 4 resident's centrally stored medications and centrally stored medication records were reviewed and observed complete. LPA observed expired PRN medication for 2 residents. LPA reviewed the PRN logs and 2 out of 2 resident's were not administered the expired PRN medications. Administrator immediately removed the expired medication and has plans for destruction. LPA reviewed 4 staff files. 4 out of 4 staff files contains a health screening, TB result, 1st Aid and CPR certification, and personnel record. 4 out of 4 staff are fingerprint cleared and associated to the facility. 4 out of 4 staff were provided annual training to include not limited to: resident rights, medication, dementia care, emergency preparedness, housekeeping and sanitation, postural support and special care. Facility has an updated emergency disaster plan. Emergency drills are completed quarterly. LPA observed emergency supplies to include first aid kits, flashlights, batteries, and non-perishable foods. Facility has an infection control plan. LPA observed an adequate amount of PPE supplies in the storage closet. Facility has a stocked PPE cart and lidded trash bins available. No deficiencies were cited today per California Code of Regulations, Title 22. This report was reviewed with Administrator, Lori Corral and MedTech, Odalys Rodriguez and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 11, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - incident visit. Administrator, Lori Corral was contacted but was unable to immediately meet LPA during visit. LPA met with lead staff (S1), Odalys Rodriguez and S2. The purpose of the visit is to follow-up on an incident report regarding a power outage at the facility on Tuesday, 05/14/2024. On Wednesday, 05/15/2024 the Department was informed of the facility's power outage on 05/14/2024 from approximately 9:00AM - 8:00PM, due to PG&E. The Administrator stated they had a backup generator for the kitchen that also powered the refrigerator, freezer, and stove. Residents were provided all their meals and provided care. No residents were under oxygen. All the residents were doing well and no one sustained any injuries, nor were sent to the hospital during the power outage. In addition to the emergency flood lights, the facility also opened all the blinds to bring light in the facility. All families were informed of the situation. All the residents did not need to be relocated. During visit, LPA toured the facility with staff (S2). LPA observed all the residents in the activity room eating breakfast and being provided their medication pass. LPA observed the facility has emergency flood lights attached to the emergency exit signs, extra flashlights, and batteries. Resident bedrooms all have linens and blankets. LPA observed the emergency food supply, water, and first aid kit. LPA observed the facility has an emergency binder. LPA interviewed staff who states all the residents were doing well during the power outage. The facility did not have issues with lighting. They had extra flashlights and lanterns in case it was needed. Activities for the residents were provided during the power outage. The facility's emergency disaster plan was obtained during visit. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with staff Odalys Rodriguez and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 22, 2024