Bella Mia Chateau, Inc. (BMC #1)

Type of visit: Case Management - Licensee Initiated

Licensing Program Analysts (LPAs) Eboni Bentley and Jessica Cho arrived at the facility to verify facility closure and to ensure no residents were receiving care and supervision at the facility. LPAs were greeted by Licensee/Administrator Zenaida Vera and granted entry after stating the purpose of the visit. LPA Bentley received notification on June 4, 2025, regarding facility closure effective June 30, 2025. A written notice was later provided, dated June 22, 2025, addressed to the residents’ family members and all pertinent parties informing of the facility closure. On today's date, LPAs conducted a tour of the physical plant. LPAs observed facility was being cleared out of items belonging to the licensee upon arrival. LPAs observed no signs of residents and the facility in operation. The resident's last day was on June 29, 2025, and the staff's last day on site is July 14, 2025. Licensee surrendered the original facility license during the visit. LPAs informed the above facility representatives of the licensing procedure for future facility operation if desired. Licensee has decided to permanently close the facility at this time. The Department will proceed with the closure as of July 14, 2025. An exit interview was conducted with Licensee/Administrator Zenaida Vera, and a copy of the report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 14, 2025

Type of visit: Case Management - Annual Continuation

On June 6, 2025 at 8:30am, Licensing Program Analyst (LPA) Eboni Bentley conducted a case management annual continuation visit. Upon arrival at the facility, LPA Bentley was greeted and granted entry by the Caregiver (CG) Ramon Vera, and explained the reason for the visit. Administrator Zenaida Vera joined shortly after and was present throughout the visit. AD Zenaida Vera has an Administrator certificate that expires on November 13, 2025. The facility is a single story building with an approved fire clearance of three non-ambulatory residents of which one may be bedridden and three approved for hospice. The facility currently has a census of one resident in care, of which one is on hospice. The one resident was present and eating breakfast. During today’s visit, LPA requested records for facility liability insurance and AD Vera stated she did not currently have liability insurance for the facility as the previous policy had lapsed. AD Vera stated she reached out to her broker to request liability insurance on June 5, 2025 but could not provide documentation of current insurance policy at the time of the today's visit. LPA observed records of previous liability insurance policy provided by AD Vera, effective October 16, 2018 - October 16, 2019. No addition liability insurance documentation was provided. Based on today’s observations, a deficiency is being cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted with Administrator, Zenaida Vera and a copy of this report LIC809, LIC809-D, and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 6, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: Jun 9, 2025

All residential care facilities for the elderly,shall maintain liability insurance covering injury to residents, ... amt of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate, caused by negligent acts,... to act of,or neglect by,the licensee or its employees. Based on record review and interview, the licensee did not comply with the section cited above, which poses a potential safety risk to persons in care. LPA observed records of previous liability insurance policy effective 10/16/2018 - 10/16/2019. No addition liability insurance documentation was provided.the state’s words, verbatim · CDSS document, Jun 6, 2025

Plan of correction: Licensee stated they will obtain documentation of current liability insurance and email CCLD by POC due date.

Type of visit: Required - 1 Year

On June 4, 2025 at 8:00am, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Bentley was greeted and granted entry by the Caregiver (CG) Ramon Vera, and explained the reason for the visit. Administrator Zenaida Vera joined shortly after and was present throughout the visit. AD Zenaida Vera has an Administrator certificate that expires on November 13, 2025. The facility is a single story building with an approved fire clearance of three non-ambulatory residents of which one may be bedridden and three approved for hospice. The facility currently has a census of one resident in care, on which one is on hospice. At 9:00 AM, LPA Bentley toured the facility with CG Vera. The home consists of 4 resident bedrooms,1 staff bedroom, 3 full bathrooms, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperatures measured between 108.3 degrees F. and 117.9 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards and doorways were free of obstructions. Kitchen was inspected and found clean and sanitary. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps and toxin substances to be secured and locked and inaccessible to residents. Kitchen appliances are operational during today's visit. CONTINUE TO LIC 809-C LPA toured the outside grounds and there is ample seating with shade. The exit gate is self latching and operational. The backyard has a small garden area. LPA observed carbon monoxide and smoke detectors in common areas and bedrooms operational. The facility’s last fire drill was conducted on June 15, 2024 and a deficiency is being cited. Emergency food and water supply was observed in the garage. First aid kit had all the required elements. A fire extinguishers is fully charged with a service date of December 9, 2024. A working telephone (714-227-5766) remains available, and the facility has a device that can be used for video teleconference purposes. LPA Bentley conducted an audit of three (3) resident files (R1-R3), two (2) staff files (S1-S2), and conducted two (2) staff interviews, and one (1) resident interview. Residents’ medication was found locked and secure and a review of the Medication and Medication Administration Record (MAR) was conducted. LPA observed three out of three residents, Residents #1, Resident #2, and Resident #3 with medication not listed on MAR and centrally stored medication form since December 2024. A deficiency is being cited. Based on today’s observations, deficiencies are being cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted with administrator, Zenaida Vera and a copy of this report LIC809, LIC809-C, LIC809-D, and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 4, 2025

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to complete the Annual Required Evaluation from Friday, June 14, 2024. LPA was greeted and granted entry by Zenaida Vera, Administrator. The facility is a single story building with an approved fire clearance of three non-ambulatory residents of which one may be bedridden and four approved for hospice. The facility currently has a census of two residents in care in which one is on hospice. During today’s visit, LPA continued to review staff and resident files. The last fire drill was conducted on June 15, 2024. LPA confirmed one employee is almost done with training requirements and the administrator's certificate and training are current. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations. No deficiencies were cited but one technical violation was given. An exit interview was conducted with Zenaida Vera, Administrator and a copy of the report, LIC 9102TV and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Jun 18, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Zenaida "Zeny" Vera, Administrator. The facility is a single story building with an approved fire clearance of three non-ambulatory residents of which one may be bedridden and approved for four on hospice. The facility currently has a census of two residents in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 105.6 and 112.7 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on December 27, 2023. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review medication appear to be being given as prescribed. LPA reviewed two of two staff training and fingerprint records.LPA reviewed two of two resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expired on November 13, 2023 and is pending. Proof of documentation supplied and check was cashed. LPA will return to facility to complete annual at a future date. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiency cited on this date. An exit interview was conducted with Zenaida Vera, Administrator and a copy of the report was given at the time of the visit.the state’s words, verbatim · CDSS document, Jun 14, 2024