Belleview Assisted Living

Type of visit: Post Licensing

On 04/08/2026 at 10:08AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a post licensing inspection. LPA met with Domingo Bonifacio, Caregiver. Administrator, Christian Summers, arrived at approximately 10:35AM and LPA explained the purpose of the visit. The facility has a fire clearance for six (6) non-ambulatory residents and a hospice waiver for two (2) residents. LPA inspected the facility with Administrator including but not limited to the bedrooms, bathrooms, kitchen, common area, storage areas, and the backyard. LPA observed all bedrooms were equipped with required furniture for the comfort and safety of the residents. LPA observed grab bars in shared residents’ bathrooms. Hallways and passages are free of obstruction. Hygiene supplies and toiletries were available. Facility temperature is maintained at 72 degrees F. Hot water temperature measures 114.4 degrees F. in residents shared bathroom. Fire extinguishers were last serviced on 08/06/2025. First aid kit was complete with manual. Carbon monoxide and smoke detectors were observed operational during visit. Facility inspection matches the sketch that was provided. Continue on LIC809C….. Continued from LIC809 LPA reviewed three (3) residents records, and three (3) staff records. LPA also reviewed the medication and Medication Administration Record (MAR) during visit. The following documents were requested for facility file and are to be submitted to CCLD by 04/16/2026: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan LIC9020 Resident roster Liability Insurance Current Administrator’s Certificate Updated facility sketch No deficiencies were cited during visit. Exit interview conducted, a copy of this report and LIC9102TV provided to Christian.the state’s words, verbatim · CDSS document, Apr 8, 2026

Type of visit: Prelicensing

On 12/09/2025 at 10:25AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced pre-licensing inspection. This is a continuation from the previous visit conducted on 11/25/2025. LPA met with Marcella Summers, Licensee/Christian Summers, Administrator and explained the purpose of the visit. On 11/25/2025 LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage and back yard. The facility has a total of five (5) bedrooms, and four (4) bathrooms. LPA observed some perishables and nonperishables foods; facility will purchase more food once licensed. There were no bodies of water present during inspection. There is sufficient lighting around the facility. Residents’ rooms are equipped with the proper furniture, bedding, and lighting. Bathrooms showers/tubs were equipped with grab bars. Passageways and hallways are free of obstruction. Locked cabinets available to store medications and toxins. Locked box in cabinet to store sharps. Hot water temperature is measured at 114.3 degrees Fahrenheit. Fire extinguisher was last serviced on 08/06/2025. Carbon monoxide and smoke detectors are present and in working conditions. First-Aid kit was observed complete. Facility inspection matches the sketch that was provided. Smoke detectors and carbon monoxide were operational. Fire extinguisher was purchased on 06/03/2025. Proper hand-washing signs, Emergency/Disaster plans/contact information, personal rights were observed posted in common areas. Continue on LIC809C... Continued from LIC809 On 12/09/2025 LPA toured the facility and observed Licensee/Administrator made corrections from previous visit on 11/25/2025. LPA Conducted COMP III on 11/25/2025. The licensee/administrator was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first resident. This notification may be done by phone, by mail, by email, or by fax. No Issues were noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 9, 2025

Type of visit: Prelicensing

On 11/25/2025 at 10:26AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an announced pre-licensing inspection. LPA met with Marcella Summers, LIcensee and Christian Summers,Administrator. The facility has a fire clearance for six (6) non-ambulatory residents. A hospice waiver for two (2) residents. LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage and back yard. The facility has a total of five (5) bedrooms, and four (4) bathrooms. LPA observed some perishables and nonperishables foods; facility will purchase more food once licensed. There were no bodies of water present during inspection. There is sufficient lighting around the facility. Residents’ rooms are equipped with the proper furniture, bedding, and lighting. Bathrooms showers/tubs were equipped with grab bars. Passageways and hallways are free of obstruction. Locked cabinets available to store medications and toxins. Locked box in cabinet to store sharps. Hot water temperature is measured at 114.3 degrees Fahrenheit. Fire extinguisher was last serviced on 08/06/2025. Carbon monoxide and smoke detectors are present an working conditions. First-Aid kit was observed complete. Facility inspection matches the sketch that was provided. Continue on LIC809C.... Continued from LIC809 The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB): 1. LPA observed facility does not have a dementia care plan in place. 2 LPA observed facility does not have grab bar near toilet in one of the restrooms Licensee/Applicant will submit proof of corrections to CCLD on/before 12/02/2025. COMP III conducted during today's visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 25, 2025

Type of visit: Case Management - Other

On 11/25/2025 at 11:52AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted a component III presentation with Licensee/Administrator. LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participants gained knowledge about running and maintaining the facility in accordance with regulations. Licensee was reminded of the statute that requires CCL to be notified within 5 business days of admitting their first client. This notification may be made by phone, by mail, or by fax. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 25, 2025