Bella Cortina Residential Care Facility

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Janira Arreola and Seo Jeon conducted an unannounced visit to the facility in order to conduct a case management visit. LPAs met with Administrator, Faiz Khan, who was informed of the purpose of the visit. LPAs conducted a walk through, interviews, and records review. During the visit it was revealed by the Administrator that an incident of suspected abuse had been reported to the Administrator. LPA conducted a file review of incident report reported to the Department however no incident reports were submitted. According to California Code of Regulations Title 22, 87211 Reporting Requirements a written report shall be submitted to the licensing agency within seven days of the occurrence of any incident which threatens the welfare, safety or health of any resident. This regulation section was discussed with the Administrator during the time of the visit. A deficiency was cited and a plan of correction was created with the Administrator. An exit interview was conducted where this report, appeal rights, LIC809D page, was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 1, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Sep 4, 2026

87211 Reporting Requirements (a)...licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of...(D)Any incident which threatens the welfare, safety or health of any resident... This requirement was not met as evidenced by; Based on interviews and records review the facility did not report suspected physical abuse to the Department within the required time frame. This poses a potential health saftey or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 1, 2026

Plan of correction: The Administrator agreed to conduct outside resource training on mandated reported of suspected abuse and neglect due by the POC due date.

Type of visit: Required - 1 Year

On August 13, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Annual Inspection and met with the Administrator, Faiz Khan. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for six Elderly Adults and is currently operating at full capacity of four Elderly Adults (740). the Licensee is operating within the scope of the licensee. LPA Mixson toured the facility along with the Administrator, Faiz Khan and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. Additionally, there were no bodies of water on the premises. LPA discussed and reviewed sections included in the Care Tool. The facility phone number is (951) 208-4125 and it is operable. LPA Mixson observed the four residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA Mixson inspected two full facility bathrooms, and the hot water temperature tested within regulations. 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. LPA Mixson observed required postings such as "If you See Something, Say Something,” and the "Personal Rights." The cleaning supplies and sharp items were locked and inaccessible to the residents in care presently. 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 that the medications were locked and inaccessible to residents in care, and there was a sufficient supply of medications. The facility was clean, the furniture was in good condition at the time of this visit. The facility cooling system and other appliances were operable currently at the time of this visit. The Administrator,Faiz Khan informed LPA there are safety lights for night throughout the facility. Non-perishable and perishable food supply was sufficient per regulations, and there are a variety of food types available. Dishes and utensils were in sufficient supply and stored properly, and sharp items were observed to be locked at the time of this visit. LPA observed that there were adequate staff present for the supervision and care of the residents. LPA saw the floor plans, telephone numbers and personal rights were found posted in the facility. The listed Administrator, Faiz Khan has a current administrator’s certificate with an expiration date of 08/03/2027. LPA reviewed staff files and reviewed the facility's staff schedule. The staff files reviewed have criminal clearance and updated training along with First Aid Certification. LPA Mixson reviewed the facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill met the department standards, 07/10/2026, and was conducted by Melissa Morosie. LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures. Annual sections covered were within Regulations per Title 22, Division 6 of the California Code of Regulations at the time of visit. An exit interview was conducted. A copy of this report was discussed and given to Administrator,Faiz Khan.the state’s words, verbatim · CDSS document, Aug 13, 2026

Type of visit: Required - 1 Year

On August 12, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with the Administrator, Musarrat Khan. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for six Elderly Adults and is currently operating at full capacity of six Elderly Adults (740). LPA Mixson toured the facility along with the Administrator, Musarrat Khan and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. Additionally, there were no bodies of water on the premises. LPA discussed and reviewed sections included in the Care Tool, following is a summary. Physical Plant: The facility phone number is (951) 208-4125 and it is operable. LPA Mixson observed the four residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA Mixson inspected two full facility bathrooms, and the hot water temperature tested within regulations. 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. LPA Mixson observed required postings such as "If you See Something, Say Something,” and the "Personal Rights." The cleaning supplies and sharp items were locked and inaccessible to the residents in care presently. 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. Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. 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. The Administrator, Musarrat Khan informed LPA there are safety lights for night throughout the facility. 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. Care & Supervision/Administration: Adequate staff are present for the supervision of resident in care. Floor plans, telephone numbers and personal rights were found posted in the facility. The listed Administrator, Faiz Khan has a current administrator’s certificate with an expiration date of 08/03/2027. Records Reviewed and Resident/Staff Files: LPA reviewed staff files and reviewed the facility's staff schedule. The staff files reviewed have criminal clearance and updated training along with First Aid Certification. Resident files reviewed had required paperwork. Disaster preparedness: LPA Mixson reviewed the facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill met the department standards, 07/12/2025, and was conducted by Administrator. Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures. Annual sections covered were within Regulations per Title 22, Division 6 of the California Code of Regulations at the time of visit. An exit interview was conducted. A copy of this report was discussed and given to Administrator, Musarrat Khan.the state’s words, verbatim · CDSS document, Aug 12, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to amend a complaint report. The LPA met with Administrator, Musurat Khan, and informed her of the purpose for the visit.the state’s words, verbatim · CDSS document, Dec 4, 2024

Allegation investigated: Staff mismanaged resident's medication.

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegation. The LPA met with Administrator, Musarrat Khan, and informed her of the purpose for the visit. A report was received by the Department alleging Resident One (R1) received the incorrect medications, which belonged to another resident in care, resulting in a hospitalization. The investigation included staff and resident interviews, review and collection of relevant documentation, and a tour of the interior and exterior areas of the home. R1 was interviewed and confirmed they were given the incorrect medication on one (1) occasion. R1 reported Staff One (S1) prepared the medications and Staff Two (S2) issued the medications to them on a meal tray. R1 reported they did ingest the medications that were provided. R1 reported staff noticed the medications were incorrectly given about five minutes later. R1 reported they were sent to the hospital as a result of taking the incorrect medications; however, they denied any negative symptoms attributed to the medications. S1 was interviewed and confirmed R1 was issued the wrong medications on 10/09/2024, at Substantiated around 10:00 AM. S1 reported they prepared the medications in cups, left the medications on a meal tray on the kitchen counter, stepped away to use the restroom, and when they returned, noticed one tray was gone about five (5) to ten (10) minutes later. S1 reported they observed R1 had the missing tray and immediately noticed the medications were incorrectly given. S1 reported as a result of the medication error, Manager, Faiz Khan, and R1's nurse practitioner were contacted. S1 reported the nurse practitioner recommended R1 be sent to the emergency room due to the amount of medications the resident took, which was about ten (10) pills. S2 was interviewed and confirmed R1 was incorrectly given the wrong medications after they (S2) issued the wrong meal tray to the resident. S2 reported they could not read the name on the tray, though believed it was R1's tray based on the arrangement the tray was in. S2 reported they did not observe R1 to have any symptoms after taking the incorrect medications. S2 reported the manager, Faize, and the nurse practitioner were contacted. S2 reported emergency services was contacted after R1's blood pressure had been monitored and once the resident agreed to be sent out to the hospital. R1's Admission agreement revealed the resident was to receive assistance with medication administration. An After Visit Summary that was on file at the facility revealed R1 was hospitalized on 10/09/2024 for both Dizziness and Drug Overdose. No diagnosis was listed on the report. Medical records were subpoenaed on 10/14/2024; however, they were not obtained prior to the closure of the investigation. An Unusual Incident/Injury Report (UIR) was obtained from the facility on 10/10/2024. The report revealed the date of the incident was 10/09/2024. The report revealed staff accidentally took another resident's medication cup with the tray to R1. The report revealed manager, Faiz, the Administrator, Musarrat Khan, and R1's nurse practitioner were notified of the incident. The report revealed R1's vitals were immediately checked, and the resident was observed to be stable and their normal self. The report revealed R1 was later transported to the hospital for observation. Therefore, based on interviews and records, this allegation is deemed SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. This violation posed a potential threat to the health, safety, and personal rights of the resident in care. A citation will be issued. An exit interview was conducted; this report was reviewed with Administrator, Musarrat Khan, and a copy, along with the LIC 811, LIC 9098, and instructions on appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 16, 2024 · control 18-AS-20241009202048

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Oct 16, 2024

Incidental Medical and Dental Care: (a) A plan for incidental medical & dental care shall be developed by each facility. The plan shall encourage routine medical & dental care & provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met, as evidenced by: Based on interviews and records, R1 was administered the wrong medications on 10/09/2024 resulting in a hospitalization.the state’s words, verbatim · CDSS document, Oct 16, 2024

Plan of correction: Proof of training on new medication procedures and on the six rights of safe medication administration was observed on file. POC is cleared.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs), Stephanie Martinez and Armando Perez, conducted a required annual inspection at the facility. The LPAs were allowed entrance into the facility and met with Co-Administrator, Vijethaa Balaji. The LPA informed the Co-Administrator of the purpose for the visit. The inspection included the following: Physical Plant: The facility consists of four (4) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, a kitchen and dinning area, a living area, a laundry room, garage, and a patio and yard with sufficient seating and space for activities. There are no bodies of water located on the property. According to the Co-Administrator, no weapons are stored in the home. The facility is being maintained at a comfortable temperature. All outdoor and indoor passageways are kept free of debris and other trash. There are grab bars for each toilet, bathtub and shower used by residents. Resident showers have non-skid mats or strips present. The smoke and carbon monoxide detectors were tested and observed to be in operating condition. The home was kept clean and free of any odors. Food Service: A variety of food was available. Sufficient dinning supplies were available for residents in care. Record Review: Staff responsible for direct care and supervision have current first aid and CPR training. Staff Two (S2) did not have current Dementia training, postural support training or hospice training on file; which are required annual training. S2 had some training related to restricted health Conditions; however, the training was incomplete. No staff file was available for Staff Three (S3) or Staff Five (S5). According to the Co-Administrator, no file was available for S3 because the staff just started working at the facility. According to S3, they have been working at the facility for two days. According to the Co-Administrator, S5 does not have a personnel file due to the individual being a volunteer. She reported S5 has been working for the facility for approximately two weeks. LPAs observed S5 to be present and working at the facility during the visit. S5, however, did not have a fingerprint clearance. According to the Co-Administrator, S5 works at the facility 40 hours per week and does activities with the residents in care. The facility was not operating beyond the conditions specified on the license. The facility currently has an approved Hospice Waiver for two (2) residents and there are currently no residents in care receiving hospice services. There is a disaster and mass casualty plan in place. Medication Review: The LPA inspected resident medications. Medications were observed to be well organized, labeled and inaccessible to unauthorized individuals. An exit interview was conducted with the Co-Administrator, in which this report was reviewed and a copy was provided, along with the LIC 811, LIC 9098, LIC 421BG, and instructions on appeal rightsthe state’s words, verbatim · CDSS document, Aug 15, 2024