Bella Garden Residential Senior Care

Type of visit: Required - 1 Year

On 1/29/2026 at 11:45 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with caregiver Ana Delgado and was granted entry to the facility. Caregiver Ana called the administrator Elizabeth Colunga and she arrived 20 minutes later. At the time of the visit there was one (1) staff present, and five (5) residents present. The facility is a three (3) bedrooms, two (2) bathrooms home with a kitchen/dining area, living room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory and two (2) hospice care resident and the current census is six (6) residents. LPA was accompanied by Caregiver Ana 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 72 degrees Fahrenheit. 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. LPA measured and observed the water temperatures in the bathroom to be at 105 degrees Fahrenheit. 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, and the disaster plan were posted in a common area. LPA observed that the facility did not have an updated disaster drill. Deficiency will be issued. ***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 Medication Closet with the resident’s medications locked. LPA observed complete first aid kit and manual at the facility. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food were observed. LPA observed that the facility does not have sufficient 7 day non-perishable food. Deficiency issued. Care & Supervision: The facility has an Administrator 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. Record Review: LPA reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed resident #4 (R) ddid not have an updated tubeculosis (TB) test on file. Deficiency issued. LPA reviewed three (3) staff and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications/Medication Administration Record (MAR) were audited and in compliance. Based on the observations made during today’s visit, three (3) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C, LIC809D forms, and Appeal Rights was discussed and provided to Ana Delgado.the state’s words, verbatim · CDSS document, Jan 29, 2026

Type of visit: Required - 1 Year

On 1/22/2025 at 08:35 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA Serrano met with caregiver Ana Delgado and was granted entry to the facility. Caregiver Ana called the administrator and administrator had a court appointment and not able to come to the facility. At the time of the visit there was two (2) staff present, and five (5) residents present. The facility is a three (3) bedrooms, two (2) bathrooms home with a kitchen/dining area, living room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory and two (2) hospice care resident and the current census is six (6) residents. LPA Serrano was accompanied by Caregiver Ana 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 72 degrees Fahrenheit. LPA 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. LPA observed sufficient furniture and lighting throughout the facility. LPA Serrano measured and observed the water temperatures in the bathroom to be at 118 degrees Fahrenheit. 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, and the disaster plan were posted in a common area. LPA observed that the facility did not have the Infection Control Plan available for review at the time of inspection. Deficiency will be issued. ***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 Medication Closet with the resident’s medications locked. LPA Serrano observed complete first aid kit at the facility. Food Service: 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 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. Record Review: LPA Serrano reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA Serrano observed resident files reviewed were complete. LPA Serrano reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications/Medication Administration Record (MAR) were audited and in compliance. Based on the observations made during today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D forms, and Appeal Rights was discussed and provided to Ana Delgado.the state’s words, verbatim · CDSS document, Jan 22, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to this facility to return facility records and discuss issues found during LPA's review of records. LPA met with licensee Elizabeth Colunga who was informed of the reason for the visit. On 01/12/2024, LPA conducted an unannounced required annual visit for this facility however no staff or resident records were available for review. As part of the correction plan and, as agreed upon by Licensee and LPA, Licensee brought facility records to the Regional Office on 01/16/2024 for LPA Bueno to review. LPA has returned all staff and resident records to the facility during this visit. All deficiencies cited on 01/12/2024 has been satisfied. Letters for cleared proof of correction were issued during today's visit. Personnel records review: LPA reviewed employee records for fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, including Dementia care. LPA confirmed that administrator certification is current but awaiting verification from the Department. Resident records review: LPA reviewed resident files and found current medical assessments and TB test results, necessary consent forms, identification and emergency information, appraisal needs and service plans, admission agreement, and personal rights notification. LPA found that Resident 1 (R1) is diagnosed with Dementia. This facility does not have an approved Dementia care plan. This poses a potential health and safety risk to residents in care. Refer to LIC 809D for deficiency cited. An exit interview was conducted where this report, LIC809-D, and appeal rights were discussed with and provided to licensee Elizabeth Colungathe state’s words, verbatim · CDSS document, Jan 19, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(1) · Plan of correction due date: Jan 31, 2024

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (1) The facility has a nonambulatory fire clearance for each room that will be used to accommodate a resident with dementia who is unable to or unlikely to respond either physically or mentally to oral instructions relating to fire or other dangers and to independently take appropriate actions during emergencies or drills. This requirement was not met as evidenced by: Based on records review, Resident 1 (R1) has a Dementia diagnosis when the facility does not have an approved Dementia care plan. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 19, 2024

Plan of correction: Licensee shall submit an exception request for R1 to include regulation complaince and state that Dementia care will not be advertised by this facility. Otherwise, Licensee will need to remove R1 from the facility. If Licensee chooses to admit new residents with Dementia, Licensee shall submit a new operation plan to include Dementia Care. Proof shall be submitted to the Department no later end of POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility for a required annual inspection. LPA was greeted by staff who was informed of the purpose of the visit. Staff notified Licensee of LPAs arrival and Licensee arrived during the visit. LPA toured the interior and exterior of the home with staff and then with Licensee. Physical Plant and Operational Requirements: LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the residents. Lighting is sufficient for safety and comfort. Water temperature was measured and Licensee made corrections during today's visit to ensure compliance. Cleaning supplies and hygiene provisions are kept locked and secured. Fire extinguishers were observed to be charged and last inspected on 01/10/2023. LPA tested carbon monoxide detectors while Licensee tested interconnected smoke alarms and all were found in working order. All outdoor and indoor passageways and ramps are free of obstruction. A locked area is provided for medications and sharp objects. There is a working telephone at this location. The LIC 610E and emergency client files are maintained. Licensee presented current plan of operation and admission agreement. LPA observed Resident rights, house rules, and complaint posters and grievance procedures are posted in the facility. Resident Files, Personnel Files/Training, and Medication Records: LPA reviewed centrally stored medication list and all scheduled and PRN medication and found that they were administered as prescribed. Neither resident nor staff records were unavailable for review during today's inspection. This poses a potential health and safety concern for residents in care. All records shall brought into the Regional Office no later than end of business of correction date for LPA Bueno to review. Food Service: LPA was present during lunch time. The meal is adequate to meet the nutritional needs of the residents. Kitchen and dining areas were kept clean and organized. Food supply meets the requirement of 7 day supply of nonperishable and 2-day supply of perishables food items. Refer to LIC 809D for cited deficiencies and technical violations for issues related to deficiencies. An exit interview was conducted where this report, LIC 809D, LIC9102A, and appeal rights were discussed and copies provided to Licensee. Additional technical notes were provided electronically to Licensee.the state’s words, verbatim · CDSS document, Jan 12, 2024