Bellara Senior Living

On this day, April 1, 2026, while at the facility investigating a complaint (Control # 15-AS-20260326120524) and upon conducting interviews and record review, Licensing Program Analyst (LPA) Delmundo learned that the resident's 1:1 is not fingerprinted. LPA also learned that the facility did not submit incident report and SOC341 for the alleged financial abuse that occurred on January 2026. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section # 87355(e)(2) and will continue until corrected. Failure to submit proof of correction by plan of correction due date for the other deficiency may result in additional civil penalty. Deficiencies, civil penalty, and plan and proof of corrections were discussed with ED. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.

S1 stated that staff, S2, reported to S1 that R1 went down to the front desk on the day of the incident. S1 further stated it was R2's family member, FM2, who sent her text message about the incident and S1 assumed FM2 reported the incident to FM1. S1 stated FM2 indicated that R1 and R2 had a fight because R2's cpap was broken. S1 stated she went to R1 and R2's apartment on 10/19/25 and observed R2's arm has bruise and that R2 reported R1 grabbed R2. ED stated the incident happened after ED was gone for the day and that S1 and S2 reported the incident to the ED that night. FM1 stated that R1 and R2 had an incident on 10/18/25, of which R2 punched R1 in the ribs. R2 admitted the physical altercation to FM1 but the incident was not reported by the facility to FM1. FM1 further stated that on the day of incident, R1 went down to the front desk and called FM1 to report the incident. R1 was crying and distraught. R1 stated having altercation with R2 and that R1 grabbed R2 in the arm. R2 stated pushing R1 during the altercation. Review of email communications revealed it was FM2 who reached out to ED on 10/19/25 regarding the incident and the email was only responded on 10/21/25. Based on information gathered, the allegation is substantiated. Deficiency is cited from Title 22 California Code of Regulations and listed on 9099D. Failure to submit proof of correction by plan of correction due date and any repeat violation may result in civil penalty. Deficiency and plan and proof of correction were discussed with ED. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 S2 confirmed the incident that R1 went to the front desk staff. The front desk staff called her, and she along with the care staff, S3, went to R1 and R2's apartment. R2 broke down and admitted to calling R1 out from drinking alcohol which made R1 got out of control. S2 further stated that they facilitated R2 and told R1 to watch tv. R1 and R2 are not on hourly check and S2 only provides passing of medications to R2. S1 confirmed the incident; however, S1 was off on the day it happened. R2 admitted to having an altercation with R1 and that R2 pushed R1 in the ribs. R2 further stated R1 grabbed him in the arm which R1 admitted but R1 does not remember the date it happened. ED stated a personal companion provided by a third party was placed for R1 back in December 2024 until the family discontinued paying the 3rd party. ED further stated that R1 and R2 are not on hourly check which LPA confirmed upon review of Service Plan. Based on all the information gathered, the allegation is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit interview conducted and copy of this report provided.

LPA interviewed the DFO who stated that the issue is not ignored. DFO indicated he had communicated with a family member and recommended the plug-in light as an alternative as he continues to research for a potential light switch that will be more convenient. DFO further stated that he had a conversation with the building contractor sometime last week. Although the building contractor informed him that it is okay to purchase the light switch to replace the motion sensor light, but because it is electrical, he would like to have the contractor do the work. On this same day, DFO called the contractor to schedule the replacement of the bathroom lights. Based on information gathered, the allegation is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit interview conducted and copy of this report provided.

While at the facility investigating a complaint (Control # 15-AS-20251021141652) and upon interviews and review of the Department's incident reports for the facility, Licensing Program Analyst (LPA) Delmundo learned that the facility did not report the incident that occurred on 10/18/25 between residents, R1 and R2, to appropriate agencies. Review of R1 records showed R1 has major neuro cognitive disorder, can not leave the facility unassisted, has wandering and sundowning behaviors. Executive Director (ED) Jeff Sumabat stated when R1 and R2 moved-in, a wander guard was issued for R1; however, during interview, LPA observed R1 without wander guard. ED also stated that care conference was conducted with the residents' family and medical provider, however, R1 was resisting care and a personal companion which was placed in December 2024 for R1 was discontinued in March 2025 by the family. LPA learned that service plan was not updated accordingly after the incident happened on 10/18/25. Review of R2's Physician's Report dated 9/10/25 revealed R2 needed assistance with medications including administration of injection and R2's Care Plan was also not updated to reflect the change. Deficiencies cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of corrections by plan of correction due dates and any repeat violation may result in civil penalty. Deficiencies and plan and proof of corrections were discussed with ED. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.

Based on the information obtained, the preponderance of evidence is met; therefore, the allegation is substantiated. Deficiency is cited from Title 22 California Code of Regulations and listed on 9099D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with ED. Exit interview conducted. Appeal Rights and a copy of this report provided. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA Interviews with 16 residents did not reveal any instances in which their freedom of movement was restricted inappropriately. 16 out of 16 Residents stated they were able to move freely within the facility and access common areas consistent with their individual care plans. Allegation: Licensee does not ensure that residents are provided a healthful environment while in care - Unsubstantiated It was alleged that the licensee does not ensure that residents are provided a healthy environment while in care. During the investigation, LPA conducted interviews with 16 residents, 10 staff, reviewed facility records, and observed a display case with alcohol. Interviews with 11 residents did not indicate concerns regarding alcohol served at the facility, safety, or overall healthfulness of the environment. Resident 1 through Resident 11 stated, “Every Thursday, the facility has happy hours that offer us alcohol; however, facility staff never tried to sell any alcohol. R1 through R11 stated, “The facility offered alcohol to us; however, they based their decision on our medical records, and those who cannot drink were not offered.” S1, S2, and S3 stated, “We don’t ever charge for that; it was just part of our beverages that we offered”. LPA reviewed facility admission agreements; there was no indication of alcohol charges in the admission agreement. Allegation: Licensee does not ensure that the facility is kept in a sanitary condition – Unsubstantiated It was alleged that the licensee does not ensure that the facility is kept in a sanitary condition. Observations made by the LPA on 1/30/26 and 3/3/26 did not reveal unsanitary conditions, including accumulation of trash, odors, pests, or other conditions that would pose health risk to residents. LPA toured a random section of the random Memory Care (MC) apartment (APT) and Assisted Living (AL) apartments. LPA toured the MC and AL apartment, including but not limited to APT: 201, 202, 215, 225, 217, 222, 225, 505, 506, 502, 501, 316, and 133. All APTs are clean and sanitary. There is no odor in any of the apartments. Report continued on LIC 9099c1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA conducted 16 random selections of residents. 16 out of 16 residents interviewed did not report concerns regarding sanitation or cleanliness of the facility. LPA conducted 10 Staff interview and 10 out of 10 stated that routine cleaning schedules and sanitation practices are in place and followed to maintain a clean environment. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of property

Licensing Program Analysts (LPAs) Jill Clancy-Czuleger and David Doidge conducted an announced Component III Training. Component III was attended by Jeff Sumbat (Executive Director) and Regional Vic President of Operations (VPO ) Zach Butcher. LPA Clancy-Czuleger presented the training via Power Point presentation and had a discussion with the ED and . Exit interview conducted and copy of this report provided at the conclusion of the training