Bella Nova Villa

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct the required annual visit today. Upon arrival, the LPA was greeted by Administrator, Maria Ayala and the reason for the visit was explained. Entrance interview conducted. Beginning at 09:50 a.m., the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed: Kitchen: The LPA inspected the kitchen/food service area at approximately 09:52 a.m. Knives and sharps were observed in a locked cabinet at the time of the visit. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Common Areas: This includes the living room and dining room area. Furniture in the common areas was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature. The LPA observed a non-functional fireplace in the living room; adequately covered at the time of the visit. Report Continued on LIC 809C... Report Continued from LIC 809... The LPA observed activity supplies in the living room accessible to residents in care. The LPA observed several fire extinguishers throughout the facility new with a purchase date of 07/11/2026. Required postings were observed throughout the common space. There is a working telephone on premises. Cameras were observed in the common areas. No hazards/obstructions observed inside or out. Restrooms: There are two (2) restrooms for resident use. Bathrooms were clean and fixtures were in operating condition. Showers had non-skid surfaces and grab bars. The bathrooms were sufficiently stocked with all necessary supplies. Starting at 10:01 a.m., the hot water temperature was measured in resident bathrooms, and they measured between 106.1 – 106.7 degrees Fahrenheit which is within the required range of 105 – 120 degrees Fahrenheit. Bedrooms: There are three (3) bedrooms for resident use. Bedrooms are designated shared / double occupancy. Bedrooms were observed to be furnished appropriately and had sufficient lighting. Additional clean linens and towels were observed in a closet by the hallway. Garage: The garage was locked at the time of the visit. A sufficient supply of emergency food and water was observed. Cleaning supplies and toxins were observed locked and inaccessible at the time of the visit. Personal hygiene items are maintained locked and inaccessible from residents in care. Laundry Room: Washer and dryer were observed in the laundry room. Detergents were observed in a locked cabinet at the time of the visit. Backyard: The backyard has a shaded area with adequate furniture for resident use. Emergency passageway was observed to be clear of any obstructions. There are two (2) side gates with latching mechanisms for emergency purposes. No bodies of water noted at the time of the visit. Report Continued on LIC 809C... Report Continued from LIC 809C... Records: Record review began at approximately 10:30 a.m. Six (6) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, preplacement appraisals, appraisals, and current needs and services plan. All files were in order. Six (6) personnel files were reviewed for, but not limited to: personnel record, health assessment with negative TB test results, criminal record clearance, first aid/CPR training, and the appropriate yearly training. All personnel files were complete. Medications: The LPA conducted a medication review at approximately 01:00 p.m. Medications are centrally stored and kept in a locked cabinet by the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appear to be administered as prescribed at the time of the visit. Emergency Disaster Plan: During today’s visit, the LPA reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; last disaster drill conducted on 08/13/2026. No citations issued at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 1, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 10:45AM. The LPA met with the Licensee Maria Ayala and informed them of the reason for the visit. Entrance interview conducted. Beginning at 10:54AM, the LPA and Licensee toured the physical plant areas inside and outside to ensure there were no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed knives, medications, and files stored inaccessible in a cabinet. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. COMMON AREAS: There was a laundry room that connected the kitchen and garage. The laundry machines were in good condition and had cabinets that contained general emergency supplies. The garage remained secure and contained emergency food and water, files, cleaning supplies, and a refrigerator/freezer with extra food. At the time of the visit, the living room and dining room furniture were observed to be in good condition. The living room had a fireplace that was inoperable and screened. Required postings were observed in the entryway walls. The facility maintained a comfortable temperature throughout the visit. Nightlights were observed throughout the facility. Report Continued on LIC 809-C BEDROOMS/RESTROOMS: There were four (4) total bedrooms: two (2) private resident bedrooms and two (2) shared resident bedrooms. Bedroom #1 had a direct exit to the outside and was approved for one (1) Bedridden resident. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were stored in closets and cabinets in the hallway. There were three (3) total restrooms in the facility: one (1) guest restroom, one (1) private resident restroom, and one (1) shared resident restroom in the hallway. Restrooms were clean, sanitary, and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 106.5 degrees F and 106.9 degrees F, which is within the required range per regulation. OUTDOOR AREA: The surrounding grounds had a shaded patio area equipped with furniture in good condition for residents and visitor use. The rear also had exercise equipment for resident use. There were two (2) emergency exits located on the sides of the facility that were self-latching. All exits and passageways were free of obstruction. RECORDS: Record review began at 11:01AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order at this time. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 09/05/2025. Smoke and carbon monoxide detectors were tested at 12:48PM and were operational. Two (2) fire extinguishers were observed and were purchased on 08/01/2025. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 12:50PM. Medications were centrally stored and kept inaccessible. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced required annual visit to the above facility. LPA met with the Administrator Maria Ayala and explained the reason for the visit. Medication Audit: At 3:20 p.m. a medication audit for three (3) residents was initiated. The following was observed: The medications were stored in a locked kitchen cabinet which is locked and inaccessible to the residents in care; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. During Resident #1 (R#1's) audit, the LPA observed the following over the counter medications without a prescription, D-Mannose with Cranberry & Hibiscus 1,300 mg. Upon observation the Administrator stated that R1's family member had brought that medication. R1's family member was contacted and confirmed they had brought that medication in error in place of the prescribed Cranberry extract 500mg, and was able to bring the correct medication during the visit. At 03:51 p,m. the LPA toured the physical plant areas inside and outside with the administrator to ensure there are no health and safety hazards. LPA tested the smoke alarms and carbon monoxide detector which functioned properly. The fire extinguisher was recently purchased in August of 2024. KITCHEN: Kitchen knives are stored in a locked cabinet in the kitchen along with the medications. The supply of dishes, utensils, pots, pans and drink ware is adequate.. The supply of perishable and nonperishable food is adequate. There are no toxins in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Kitchen, laundry and house cleaning supplies are stored in the locked garage. No flies or other vermin were observed. The garage was observed locked and contained the emergency food supply, and a laundry area that contained laundry supplies. Report will continue on LIC809-C. (2ND PAGE). Bedrooms: There are two (2) shared rooms and two (2) single rooms. All resident rooms had appropriate furnishings, clean linens, and adequate lighting. Restrooms: There are three (3) total bathrooms at the home. One (1) is designated as a staff bathroom, one (1) is in the common hallway, (1) restroom is in a shared bedroom for resident use. The resident bathrooms have a shower with non-skid materials. The toilet and showers have grab bars. Hot water temperature was measured at 113.5*F in both resident bathrooms. Common Spaces: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. LPA observed the required postings in the common hallway. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. Record Review: At 4:28 p.m. a review of facility files was initiated. The LPA reviewed five (5) out of six (6) resident files. The following was observed: One resident (R2) did not have their required updated Physician medical assessment (LIC602) due to their Dementia diagnosis. Upon observation the administrator stated that they had taken R2 to get their physical already however, the Physicians office did not want to release the form until the TB results were out. The administrator called R2's physician office and they confirmed that the physical was done and awaiting TB results and stated they would be sending it soon. The LPA advised the Administrator to review R3’s file, as their LIC602 indicated that R3 was bedridden, however the LPA observed R3 able to move and walk. The LPA reviewed four (4) out of seven (7) staff files. Al files were complete and current. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit inter view conducted and copy of the report and appeal rights provided to Administrator Maria Ayala.the state’s words, verbatim · CDSS document, Sep 16, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.