Bela Vida Care Home

Type of visit: Required - 1 Year

On November 5, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Joseph Sol and licensee Genevive Tan who greeted the LPA. LPA explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory and one (1) may be bedridden elderly resident ages 60 and above. The facility is approved for (6) hospice residents. Currently, the facility has one (1) resident in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) resident's rooms, two (2) common bathrooms, one (1) staff room, a living area, a dining area, a kitchen, an outside seating area and a garage used for storage. LPA and license toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 109.8 degree F. A comfortable temperature of 74 degree F. was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Evaluation Report Continues LIC 809-C Fire extinguisher was charged, smoke detectors and carbon monoxide were operable. The facility has conducted a Disaster Drill on 10/25/25. A review of the Medication Administration Record (MAR) was complete and accurate. A landline telephone was in working condition. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. The facility had Food Menu and Daily Plan Activities calendar were posted. LPA observed First Aid Kit was maintained. The facility has current liability insurance on file effective 09/11/25 - 09/11/26 policy # BSICDMRC0107128525AL. The facility is current on Community Care Licensing annual dues. The facility has a current Administrator's Certificate for Joseph Sol #700126340 Exp. 12/13/25. An audit of residents #1-# (R1-R4) service files and staff #1-#4 (S1-S4) personnel files revealed to be complete. No deficiencies issued. Technical Advisory Violation issued. (see LIC 9102) An exit interview conducted with Joseph Sol and a copy of report was provided.the state’s words, verbatim · CDSS document, Nov 19, 2025

Type of visit: Prelicensing

On 12/18/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted announced visit to this home. LPA was greeted by applicants Genevieve Tan, Ediberto Bernardino and Joseph Sol and explained the purpose of today’s pre-licensing inspection visit. An application was submitted to CCLD on 04/05/24 in the initial license application for a Residential Facility for the Elderly, ages 60 years and above. The applicant requested a capacity of six (6) individuals, of which maybe five (5) non-ambulatory, and one (1) bedridden. Structure: The home is a three (3) bedroom, two (2) bathroom, one story home with a two (2) car garage situated in a residential neighborhood. The home includes a living, a dining, a kitchen, and a laundry area. The living room does not include a fireplace. The living area included recliners. The kitchen has a refrigerator and stove. The rear exterior is fenced throughout. The passageways, walkways, and steps are free from obstructions. Bedrooms Residents: The facility had three (3) bedrooms for residents. There are two (2) bedrooms for shared non-ambulatory (1) of the bedrooms specific for the bedridden. All rooms include a twin-size bed, one (1) chair, one (1) nightstand, and one (1) table lamp. All bedrooms are equipped with a ceiling light. All rooms had a dresser, which complies with the requirement of 8 cubic feet of space. All rooms had closets for ample storage. Evaluation Report Continues LIC 809-C Bedrooms Staff: Bedroom #1 is designated for live-in staff. Bathrooms: The home has two (2) bathrooms. Bathrooms are accessible in all rooms. All bathrooms have a working toilet, washbasin, and shower with grab bars and non-skid mats. Linens & Hygiene Supplies: Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in each bedroom. Emergency Phone Numbers, Exit Plan & Menu: Emergency phone numbers. The exit plan and menu are posted and readily available for review throughout the home. There are two (2) fire extinguisher located in the kitchen mounted on the wall and in the garage. A telephone line is available in the living room. Emergency supplies and Personal Protective Equipment supplies are stored in the garage. The applicant submitted an approved Infection Control Plan. Food Service: Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked drawer. Food supply is adequately stored in kitchen cabinets and consists of the can goods. The kitchen counters also had small appliances. Smoke Detectors: Smoke and carbon monoxide detectors throughout the interior space. Hardwired smoke detectors in all four (4) bedrooms and hallways. Carbon monoxide is available in hallways. Toxins: All toxins are locked and stored under the kitchen sink cabinet. Evaluation Report Continues LIC 809-C Appliances: Stove burners, oven, microwave, washer, and dryer are working. The kitchen counters also had small appliances which includes a coffee maker, toaster, and Keurig. There is one (1) refrigerator in the home. The refrigerator measured a temperature of at least 40 degrees Fahrenheit for appropriate food storage. The home is equipped with central heaters and individual air conditioning systems in each resident’s rooms. Water Temperature: The water temperature is 105.1. degrees throughout the kitchen and bathrooms. Medications, First-Aid Kit & Book: A first aid kit is stored in the kitchen cabinet inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual locked and inaccessible to residents. The resident's medications will be stored in the cabinet locked in the kitchen area and inaccessible. Resident & Staff Files: The applicant is not handling the cash resources for residents. Records of staff and residents will be stored in a metal cabinet in the activity area. Reading Material, Games, Equipment & Materials: The facility has board games, books, magazines, and other recreational materials for the resident's use all stored in the activity room. Pool/Jacuzzi & Pets: There are no pets, jacuzzi, or pool in the fenced area Evaluation Report Continues LIC 809-C A Fire Clearance inspection was conducted on 10/29/24 approved for a capacity for five (5) non-ambulatory, and one (1) for bedridden. Component III: LPA Dabuet conducted the Pre-Licensing inspection along with the information provided about how to operate the facility within substantial compliance with Component III PowerPoint. An exit interview was conducted, and a copy of this report has been furnished to the applicant, Ediberto Bernardino and Genevieve Tan. LPA Dabuet will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application. End of Reportthe state’s words, verbatim · CDSS document, Dec 18, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: TAN, GENEVIEVE and Edilberto Bernardino - Licensee and Administrator Interview Method: Telephone interview On 11/14/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Nov 13, 2024