Bella Cai Care Home

Type of visit: Required - 1 Year

On 9/15/2026 at 11:20 AM, Licensing Program Analyst (LPA) Matthew Aguilar made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Administrator Charisse Magsaysay and was granted entry to the facility. At the time of the visit there were three (3) staff present, and four (4) residents present. The facility has five (5) bedrooms, four (4) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for six (6) non ambulatory residents, of which one (1) may be bedridden. The facility has six (6) hospice care waivers and the current census is four (4) residents. The facility is also licensed to care for residents with dementia. LPA was accompanied by a staff to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 78 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with the required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathroom to be at 112 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, and the disaster plan were posted in a common area. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine closet with the resident’s medications locked. LPAs observed first aid kit and first aid book at the facility. Yards/Outside: One shaded patio with a wheelchair ramp, one (1) side gate with self-latching handles on the right side of the house that leads into the backyard, attached two (2) car garage observed. All outdoor pathways were free of obstructions. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. LPA observed that the facility has sufficient 72 hour emergency food and water. Care & Supervision: The facility has an Administrator present in the facility with enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA reviewed two (2) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed resident files reviewed were complete. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed staff files are complete. LPA observed that the facility completed quarterly fire and earthquake drills. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809 was discussed and provided to Administrator Charisse Magsaysay.the state’s words, verbatim · CDSS document, Sep 15, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Administrator/Licensee- Charise Magsaysay and was granted entry to the facility. The facility is a (6) bedroom, (3), bathroom home, with a kitchen/dining area, living room, and attached garage. Licensed capacity is (6) current census (5). LPA was accompanied by Administrator/Licensee- Charise Magsaysay to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents . Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. . Record Review: LPA reviewed (5) resident file for admission agreements, updated physician reports, and needs and services plans. LPA observed 5 out of the 5 residents had missing reappraisals and pre-admissions. LPA also verified (5) resident's medications. Upon audit, LPA Rico observed 4 out of the 5 residents did not have their PRN medication documented with the date/time, reason and resident’s response. In addition, LPA observed a lose needle not dispended properly. LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screening. Based on the observations made during today’s visit, (4) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator/Licensee- Charise Magsaysay. Along with a copy of Appeal Rightsthe state’s words, verbatim · CDSS document, Oct 11, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced case management visit pertaining to residents’ eviction. LPA Rico met with staff Cresenaio Galve and explained the purpose of the visit. The Administrator Charise Magsaysay was contacted and informed about today’s visit. During today’s visit, LPA Rico conducted staff interviews, reviewed facility’s documents, and toured the facility. Upon record review, it was revealed that R1 was not provided with a 30-day eviction notice. The Administrator Charise informed LPA that R1 had requested to move out. The Administrator indicated that they had assisted with finding a new facility for R1. In addition, R1 did not provide a 30-day notice of move-out date to the facility. Per resident interview, R1 stated they did not want to move out. During facility tour, LPA observed R1 personal belongings were still located inside the facility. LPA informed the Administrator that the facility must follow Community Care Licensing Eviction Procedures. Furthermore, LPA Rico reviewed R1 physician report which indicated R1 is unable to manage own cash resources. The facility did not have residents' cash resources maintained as a drawing account which would include ledger accounting (columns for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order. A deficiency will be issued. In addition, it was revealed the facility did not have a surety bond. A deficiency will be issued. Based on the information gathered today’s visit three (3) deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (LIC809D) was discussed and provided to Administrator Charise Magsaysay. Along with a copy of appeal rights.the state’s words, verbatim · CDSS document, Jul 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468(a)(20) · Plan of correction due date: Jul 21, 2025

To be protected from involuntary transfers, discharges, and evictions.. state.. and relocation protections for residents. For purposes of this paragraph.. means a transfer, discharge, or eviction that is initiated by the licensee, not by the resident This requirement wasn't met as evidenced by: Based on interviews,and facility tour, the Administrator did not follow the proper relocaton the facility which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 18, 2025

Plan of correction: The Administrator stated they will read the regulation cited 87468.2(A)(20) and will send a self-verification letter they have read and understood the regulation. POC due date by 7/21/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR87216(a) · Plan of correction due date: Jul 21, 2025

87216(a) Bonding Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. This requirement wasn't met as evidenced by: Based on record review the Licensee did not have a surety bond which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 18, 2025

Plan of correction: The Administrator stated they will read the regulation cited 87216(a) and will send a self-verification letter they have read and understood the regulation. POC due date 7/21/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87217(g)(1) · Plan of correction due date: Jul 21, 2025

87217(g)(1)Safeguards for Resident Cash, Personal Property, and Valuables Records of residents' cash resources maintained as a drawing account shall include a ledger accounting... for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current. This requirement wasn't met as evidenced by: Based on record review the Licensee did not have a copy of R1 ledger account which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 18, 2025

Plan of correction: The Administrator stated they will read the regulation cited 87217(g)(1) and will send a self-verification letter they have read and understood the regulation. POC due date by 7/21/2025

Type of visit: Required - 1 Year

On 9/10/2024 at 09:25 AM, Licensing Program Analysts (LPA) Melody Brown and Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPAs Brown and Serrano met with Licensee/Administrator Charisse Magsaysay and was granted entry to the facility. At the time of the visit there were two (2) staff present, and five (5) residents present. The facility is a five (5) bedrooms, five (3.5) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory and six (6) hospice care and 1 maybe bedridden resident and the current census is five (5) residents. LPAs Brown and Serrano was accompanied by Staff #3 to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees Fahrenheit. LPAs Brown and Serrano inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPAs Brown and Serrano observed sufficient furniture and lighting throughout the facility. LPAs Brown and Serrano measured and observed the water temperatures in the bathroom to be at 107 degrees F at Room # 5. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws, and the disaster plan were posted in a common area. LPAs Brown and Serrano observed resident 2 (R2) and resident 3 (R3) have half bed rails. Licensee/Administrator Magsaysay reported to LPAs Brown and Serrano that R2 and R3 do not have written order from their physician indicating the need for half bed rail for mobility. Deficiency will be issued. continuation on LIC 809C Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine Closet with the resident’s medications locked. LPAs Brown and Serrano observed complete first aid kit and first aid book at the facility. Food Service: More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has an Administrator present in the facility with appropriate and enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Also, LPAs Brown and Serrano observed that the facility does not have dementia residents. Record Review: LPAs Brown and Serrano reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and centrally stored medication list and needs and services plans. LPAs Brown and Serrano observed that resident 1(R1) and resident 3 (R3) do not have the required pre-placement appraisal in their facility file. Deficiency will be issued. LPAs Brown and Serrano observed resident 3 (R3) physician report does not have a physician signature date. Deficiency will be issued. LPAs Brown and Serrano observed that resident 1 (R1), resident 2 (R2), resident 3 (R3) do not have the required needs and services plan. Deficiency will be issued. LPAs Brown and Serrano reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings and tuberculosis (TB) test. LPAS Brown and Serrano observed that staff 4 (S4) does not have the required health screening report and TB test. Deficiency will be issued. During the visit S4 complete the required health screening report and TB test. Medications/Medication Administration Record (MAR) were audited, and LPAs Brown and Serrano observed resident 1 (R1) four (4) medications were not given per R1 physicians order. Also, LPAs observed resident 3 (R3) one medication was not given per R3 physicians order. Moreover, LPAs observed R3 one (1) medication was not refilled on time, thus not given per R3's physician order. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIIC809D, LIC9102 forms, and Appeal Rights were discussed and provided to Licensee/Administrator Charisse Magsaysaythe state’s words, verbatim · CDSS document, Sep 10, 2024

The state marks this report as 16 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.