Inspection Reports for Bella Residential Care
28571 Yarow Way, Moreno Valley, CA 92555, USA, CA, 92555
Back to Facility ProfileDeficiencies per Year
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3
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1
0
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Moderate
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Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Aug 12, 2025
Visit Reason
The inspection was an unannounced Required Annual Inspection conducted to evaluate compliance with licensing regulations for the facility.
Findings
The facility was found to be in compliance with regulations, with no obstructions or hazards observed. The physical plant, medication storage, food service, care and supervision, records, disaster preparedness, and infection control measures met regulatory standards at the time of the visit.
Report Facts
Capacity: 6
Census: 6
Fire drill date: Jul 12, 2025
Administrator certificate expiration: Aug 3, 2027
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Musarrat Khan | Administrator | Met with Licensing Program Analyst during inspection and provided information about facility operations |
| Faiz Khan | Administrator | Listed administrator with a current certificate expiring 08/03/2027 |
| Venus Mixson | Licensing Program Analyst | Conducted the inspection and authored the report |
| Jazmond D Harris | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Census: 6
Capacity: 6
Deficiencies: 0
Dec 4, 2024
Visit Reason
Licensing Program Analyst Stephanie Martinez conducted an unannounced visit to the facility to amend a complaint report.
Findings
The Licensing Program Analyst met with the Administrator, Musurat Khan, and informed her of the purpose of the visit. No further findings or deficiencies are detailed in the report.
Complaint Details
The visit was related to amending a complaint report; no substantiation status is provided.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Martinez | Licensing Program Analyst | Conducted the unannounced visit and met with the Administrator. |
| Musurat Khan | Administrator | Met with the Licensing Program Analyst during the visit. |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 1
Oct 16, 2024
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that staff mismanaged a resident's medication, resulting in hospitalization.
Findings
The investigation substantiated that Resident One (R1) was given the incorrect medications on one occasion on 10/09/2024, leading to hospitalization. Staff interviews and documentation confirmed the medication error occurred due to misidentification of medication trays, and appropriate notifications and emergency response were made.
Complaint Details
The complaint was substantiated based on interviews and records. The allegation that staff mismanaged resident's medication was valid and posed a potential threat to the health, safety, and personal rights of the resident.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Incidental Medical and Dental Care: The licensee failed to assist residents with self-administered medications as required, resulting in R1 being administered the wrong medications on 10/09/2024 causing hospitalization. | Type A |
Report Facts
Number of pills ingested: 10
Capacity: 6
Census: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Martinez | Licensing Program Analyst | Conducted the complaint investigation |
| Musarrat Khan | Administrator | Facility administrator interviewed during investigation |
| Faiz Khan | Manager | Manager notified of the medication error incident |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 3
Aug 15, 2024
Visit Reason
The inspection was a required annual unannounced visit to evaluate compliance with licensing regulations at the Bella Cortina Residential Care Facility.
Findings
The inspection found the facility physically well-maintained and clean with proper safety features. However, deficiencies were noted in staff training and personnel records, including incomplete dementia, postural support, and hospice training for one staff member, missing personnel files for two staff members, and one volunteer staff member working without fingerprint clearance.
Severity Breakdown
Type A: 1
Type B: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Staff Two (S2) did not have current Dementia training, postural support training, or hospice training on file; training was incomplete. | Type B |
| No staff file was available for Staff Three (S3) or Staff Five (S5), who is a volunteer. | Type B |
| Staff Five (S5) was working at the facility without fingerprint clearance. | Type A |
Report Facts
Staff members without required training: 1
Staff files unavailable: 2
Staff without fingerprint clearance: 1
Facility capacity: 6
Census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Vijethaa Balaji | Co-Administrator | Met during inspection and provided information about staff and facility operations |
| Stephanie Martinez | Licensing Program Analyst | Conducted the inspection and authored the report |
| Armando Perez | Licensing Program Analyst | Conducted the inspection |
| Rikesha Stamps | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 2
Aug 29, 2023
Visit Reason
The visit was an unannounced annual required inspection conducted by the Licensing Program Analyst to evaluate compliance with facility regulations.
Findings
The facility was generally clean and well-maintained with proper food storage, safety equipment, and unobstructed pathways. However, two deficiencies were cited related to expired CPR/First Aid certification for Staff #1 and failure to document medication assistance on the Medication Administration Record (MAR).
Deficiencies (2)
| Description |
|---|
| Staff #1's CPR/First Aid certification expired on 4/27/2023. |
| Staff dispensed medication on 8/29/2023 but did not document assistance with medication on MAR. |
Report Facts
Capacity: 6
Census: 5
Deficiencies cited: 2
POC Due Date: Sep 8, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Deborah Johnston | Caregiver | Met Licensing Program Analyst and was present during inspection. |
| Joel Esquivel | Licensing Program Manager | Supervisor overseeing the inspection. |
| Janette Romero | Licensing Program Analyst | Conducted the inspection and authored the report. |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Aug 24, 2022
Visit Reason
Licensing Program Analyst Stephanie Torres made an unannounced visit to conduct an annual inspection with an emphasis on infection control.
Findings
The inspection found sufficient infection control measures including hand hygiene supplies, cleaning provisions, and use of face coverings. No deficiencies were cited during the visit.
Report Facts
COVID-19 positive residents: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Faiz Khan | Staff | Met with Licensing Program Analyst during the inspection. |
| Stephanie Torres | Licensing Program Analyst | Conducted the annual inspection. |
| Deborah Mullen | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 1
Aug 19, 2021
Visit Reason
The visit was an unannounced annual inspection limited to infection control, conducted after a COVID-19 Risk Assessment Screening.
Findings
The facility was found to be successfully incorporating COVID-19 infection control best practices, including availability of hand sanitizer, stocked bathrooms, and PPE supplies. However, staff had not yet been fit tested for N95 masks, and a Technical Assistance Advisory Note was issued regarding this.
Deficiencies (1)
| Description |
|---|
| Staff have not been fit tested for N95 masks. |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sana Khan | Administrator | Named in relation to infection control practices and fit testing for N95 masks. |
| Jennifer Semin | Licensing Program Analyst | Conducted the inspection and issued the Technical Assistance Advisory Note. |
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