Belrose Care Home III

Type of visit: Required - 1 Year

On 03/20/2026 at 9:00 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Rosa Junsay and explained the purpose of the visit. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 115.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 02/09/2026. Emergency Disaster Plan was last posted on 03/20/2026 . First aid kit was observed to be complete. Emergency disaster drill was last conducted on 02/26/2026. LPA reviewed 5 residents records and 5 staff records; all were complete. LPA also reviewed a sample of resident’s medications. The following documents were reviewed during the inspection:LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan, Liability Insurance, and Current Administrator’s Certificate. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 20, 2026

Allegation investigated: Staff did not provide resident's responsible party a refund.

On 10/03/2025, at 2:15 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility to investigate the allegation above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Licensee / Administrator Rosa Junsay. The complaint alleges that staff did not provide Resident R1's responsible party a refund. The LPA interviewed Witness W1 (R1's Responsible Person) by phone and the Licensee in person at the facility. W1 stated that the Licensee had not sent the refund of the June 2025 prepayment to her. The Licensee confirmed that no refund of that payment had been sent to W1. This data supports the allegation. Continued on LIC 9099-C. . . . Substantiated . . . .Continued from LIC 9099 The preponderance of the evidence standard has been met, and the allegation is SUBSTANTIATED. The deficiency is cited under the California Code of Regulations listed on LIC 9099-D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted, Appeal Rights, and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 3, 2025 · control 15-AS-20251002214702

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Oct 8, 2025

1569.652 Termination of admission agreement upon death of resident . . . (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued . . . within 15 days after the personal property is removed. This requirement is not met as evidenced by: Statement from Licensee that the $6,000 pre-payment for June 2025 had not been refunded to Witness W1.the state’s words, verbatim · CDSS document, Oct 3, 2025

Plan of correction: On or before the due date, the Licensee shall refund the fees paid in advance in full to W1.

Type of visit: Required - 1 Year

On March 26, 2025, at 8:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPA stated the purpose of the visit to Caregivers Evangeline Polito and Justo Garcia. Administrator / Licensee Rosa Junsay arrived at approximately 9:15 AM. LPA toured the interior and exterior of the facility. LPA inspected the kitchen, dining area, restrooms, community living spaces, bathrooms, resident rooms, and the grounds of the facility. More than the required minimum of 7 days of nonperishable and 2 days of perishable foods were appropriately stored. The maximum hot water temperature was 112.8 degrees Fahrenheit and the living room temperature was 73.4 degrees Fahrenheit. The carbon monoxide and smoke detectors were fully operational. The fire extinguisher was fully charged and last serviced on 1/24/2025. The LPA observed postings in the facility that included a complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council, and Rights to Family Council. An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. The LPA reviewed facility records, records of 5 staff members, and records of 5 residents. No citations issued during inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 26, 2025

Type of visit: Required - 1 Year

On 3/4/2024 at 10:30 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPA stated the purpose of the visit to Caregivers Evangeline Polito and Justo Garcia. Licensee Rosa Junsay arrived at approximately 11:15 AM. LPA toured the interior and exterior of the facility. LPA inspected the kitchen, dining area, restrooms, community living spaces, bathrooms, resident rooms, and the grounds of the facility. More than the required minimum of 7 days of nonperishable and 2 days of perishable foods were appropriately stored. Temperature in the living room was measured at 68.7 degrees Fahrenheit at 11:57 AM. Fire extinguisher was fully charged and last serviced on 12/6/2023. Carbon monoxide and smoke detectors were fully operational. The LPA observed postings in the facility that included a complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council, and Rights to Family Council. An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. The LPA reviewed facility records, records of 5 staff members, and records of 5 residents. The LPA interviewed 2 staff members and 2 residents. No citations issued during inspection. Exit interview conducted with Licensee. A copy of this report provided to the Licensee via email.the state’s words, verbatim · CDSS document, Mar 4, 2024