Vita Bella Elderly Care Iii

Maintain separate complete record for each resident

Based on review of resident records the licensee did not comply with the section cited above in 4 out of 14 resident records which poses a personal rights risk to persons in care. On 2/4/2026, LPA reviewed 4 out of 14 resident records Admissions Agreement incomplete as the Rate of Basic Services, and Payment Provisions were not complete. The facility administrator stated that all resident records Admissions Agreement will be re-reviewed and completed.

Ensure hazardous items are locked and not unattended

87309 Storage Space and Access(a)Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions... knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended.... This requirement was not met as evidenced by:The facility did not ensure a knife was locked and inaccessible to residents in care, which resulted in a incident involving a resident (R1) and facility staff (S2).

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:The facility did not ensure that a resident's bedroom window blind was in good repair. Facility stated that the window blind will be replaced.

87303(i)(1)(B) Maintenance and Operation(i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. floors or buildings shall have a signal system which shall: (B) Transmit a visual and/or auditory signal to a central staff...loud enough to summon staff.This requirement is not met as evidenced by:The facility did not ensure that the signal system master receiver was available in the facility.

Maintain physician order documentation in resident record

87608(a)(3) Postural Supports(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident…(3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record... This requirement was not met as evidence by:The facility used a belt on R1 without a written physician’s order in place.

Based on observation and interview the licensee did not comply with the section cited above. LPA and the administrator also tested two residents’ call pendants, which appeared to function properly but did not emit an auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This poses/posed a potential health, safety, or personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

Based on observation and interview record the licensee did not comply with the section cite above. LPA observed a knife and toxins made accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

87463(a)(3) Reappraisals: the pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes...reappraisals shall document changes in the resident's physical, medical, mental, and social condition...Any illness, injury, trauma, or change in the health care needs This requirement was not met as evidence by:Based on interviews and record review, the facility did not conduct a reappraisal after R1 returned from the hospital. This posed an immediate health and safety risk to R1.

Request transfer of criminal record clearance

87411(g)(2)Personnel Requirements – General(g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall:(2) Request a transfer of a criminal record clearance...This requirement was not met as evidence by: This requirement was not met as evidence by: Based on interviews, observations and record review, on 11/21/24 the facility did not ensure the volunteer staff has a California clearance and associated to the facility. This posed an immediate health and safety risk to R1.

87211(a)(1)(D) Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(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…(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident.This requirement is not met as evidenced by Based on the file reviews and interviews, the Licensee did not ensure facility reported multiple incidents reports to CCLD. This posed a potential health and safety risk to residents in care.

Certified administrator requirements and substitute coverage

87405(a) Administrator - Qualifications and Duties(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility…This requirement is not met as evidenced by Based on observation and facility visits, the Administrator has not been at facility for a sufficient number of hours and adhere to the facility LIC 500 Personnel Report.

Assist residents with self-administered medication

87465(a)(4) Incidental Medical and Dental Care...A plan for incidental medical and dental care shall be developed by each facility...The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidence by: Based on observation and file review, the Licensee did not ensure that 3 out of 4 residents LIC 622, Centrally Stored Medication and Destruction Record (CSMDR) was correct. Resident’s medications did not match up with the Start date of when the resident started their medication; therefore, it is unclear if resident received their medications This posed a health immediate safety risk to residents in care.

87208(a)(7)(A) Plan of Operationa) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:(7) Sketches, showing dimensions, of the following: (A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used for non ambulatory residents and for bedridden residents, other than for a temporary illness or recovery from surgery as specified in Sections 87606(d) and (e)This requirement is not met as evidenced by:Based on observations and interview this requirement was not met evidence by: The administrator did not ensure the facility maintained a current plan of operation. The administrator allowed two care staff to reside in a resident room. Licensee did report any room changes and did not maintain a current plan of operation by not updating facility sketch and did not submit changes to CCLD. This posed a potential risk to residents in care. and therefore, another resident was moved to reside in care staff room, which poses/posed a potential health, safety, or personal rights to person in care.

Maintain separate complete record for each resident

87506(a) Resident Records(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.This requirement was not met as evidence by: Based on observations and interview administrator did not ensure that resident 1 (R1) It was learned that the following documents were not filled out and left blank with facility staff and resident signature: LIC 603 A Resident Appraisal, LIC 601 Identification and Emergency Information, and LIC 625 Appraisal/Needs and Service Plan. The administrator did not ensure a separate and complete current record was maintained for (R1). This posed a potential health and safety risk to residents in care.

Certified administrator requirements and substitute coverage

87405(a) Administrator - Qualifications and Duties(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours…This requirement is not met as evidenced by: Based on interviews, records review and observations, the licensee did not comply with the section cited above. The licensee did not ensure that administrator is at the facility for sufficient number of hours, which poses/posed a potential health, safety or personal rights to person in care.

Ensure hazardous items are locked and not unattended

87309(a) Storage Space(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.This requirement was not met as evidence by: Based on observation, Administrator did not ensure that Lysol All Purpose Cleaner was made accessible to residents in care, which This poses a potential health and safety risk to persons in care. This posed a potential health and safety risk to residents in care.

Report specified resident events within seven days

87211(a)(1) Reporting Requirementsa) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(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 any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.This requirement is not met as evidenced by: Based on file review and interviews the Licensee did ensure staff were meeting reporting requirements and submitting LIC 624 Unusual incident reports that include elder abuse within 24 hours to CCLD. This posed a potential health and safety risk to residents in care.

Assist residents with self-administered medication

87465(a)(4) Incidental Medical and Dental Care...A plan for incidental medical and dental care shall be developed by each facility...The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidence by: Based on observation and file review, the Licensee did not ensure that 3 out of 4 residents LIC 622, Centrally Stored Medication and Destruction Record (CSMDR) was correct. Resident’s medications did not match up with the Start date of when the resident started their medication; therefore, it is unclear if resident received their medications This posed a health immediate safety risk to residents in care.

87202(a) Fire Clearance All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.This requirement is not met as evidenced by: Based on observation and facility inspection, the Licensee did not ensure the emergency fire exit door was kept unlock. This posed an immediate health and safety risk to residents in care.

Maintain fire clearance before retaining specified persons

87202(a) Fire Clearance All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.This requirement is not met as evidenced by: Based on observation and facility inspection, the Licensee did not ensure the fire extinguisher was current. Fire extinguisher was last serviced on 09/21/2023. This posed an immediate health and safety risk to residents in care.

Maintenance and operation requirements for facilities

Based on observation and facility inspection, LPAs observed broken glass, dead birds, nail screws, broken bricks, plugged sewer, exposed wires, hole on wall located at the kitchen exit door, exterior gate not in good repair, Gutter cap not installed properly, and wood board on ground. The licensee did not ensure facility was maintained in good repair. This posed a potential health and safety risk to residents in care.

Maintain separate complete record for each resident

Based on observation and file review, the Licensee did not ensure Admission Agreement Addendum had the correct facility name and information. This posed a potential health and safety risk to R1 and R3.

Based on observation and file review staff 1 and staff 2 and staff 3 did not have any training documentation in their files. This posed a potential health and safety risk to residents in care.

Based on observation and facility inspection, the Licensee did not ensure the emergency fire exit door was kept unlock. This posed an immediate health and safety risk to residents in care

Based on today's visit LPAs learned that staff 2 was not associated to facility, however, S2 was present during today's visit and were caring for residents. S3 is also not associated to the facility, however, S3 was not present at today's visit. This posed an immediate health and safety risk to residents in care

Conformance with applicable laws and regulations

Based on observation and interviews the Administrator did not follow plan of operations and did not conform to applicable laws, rules, and regulations. This posed a potential health and safety risk to residents in care.

Maintain and operate facility under definitive plan

Based on observation and facility inspection, LPAs observed Vinyl passage way enclosure was taken down. The Licensee did not ensure to follow the agreed upon plan of operation. This poses a potential health and safty risk to residents in care.