Inspection Reports for Bella Residential Care

28571 Yarow Way, Moreno Valley, CA 92555, USA, CA, 92555

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Deficiencies per Year

4 3 2 1 0
2021
2022
2023
2024
2025
High Moderate Unclassified

Census Over Time

0 3 6 9 12 Aug '21 Aug '23 Oct '24 Aug '25
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
NameTitleContext
Musarrat KhanAdministratorMet with Licensing Program Analyst during inspection and provided information about facility operations
Faiz KhanAdministratorListed administrator with a current certificate expiring 08/03/2027
Venus MixsonLicensing Program AnalystConducted the inspection and authored the report
Jazmond D HarrisLicensing Program ManagerNamed 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
NameTitleContext
Stephanie MartinezLicensing Program AnalystConducted the unannounced visit and met with the Administrator.
Musurat KhanAdministratorMet 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)
DescriptionSeverity
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
NameTitleContext
Stephanie MartinezLicensing Program AnalystConducted the complaint investigation
Musarrat KhanAdministratorFacility administrator interviewed during investigation
Faiz KhanManagerManager 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)
DescriptionSeverity
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
NameTitleContext
Vijethaa BalajiCo-AdministratorMet during inspection and provided information about staff and facility operations
Stephanie MartinezLicensing Program AnalystConducted the inspection and authored the report
Armando PerezLicensing Program AnalystConducted the inspection
Rikesha StampsLicensing Program ManagerSupervisor 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
NameTitleContext
Deborah JohnstonCaregiverMet Licensing Program Analyst and was present during inspection.
Joel EsquivelLicensing Program ManagerSupervisor overseeing the inspection.
Janette RomeroLicensing Program AnalystConducted 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
NameTitleContext
Faiz KhanStaffMet with Licensing Program Analyst during the inspection.
Stephanie TorresLicensing Program AnalystConducted the annual inspection.
Deborah MullenLicensing Program ManagerNamed 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
NameTitleContext
Sana KhanAdministratorNamed in relation to infection control practices and fit testing for N95 masks.
Jennifer SeminLicensing Program AnalystConducted the inspection and issued the Technical Assistance Advisory Note.

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