019201202-7-11-2023-15-AS-BFOG-CY9MTU-20231206085404

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201202
Report Date: 07/11/2023
Date Signed: 07/11/2023 06:21:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2023 and conducted by Evaluator Alicia Delmundo

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20230705170957

FACILITY NAME:	BELLA VISTA		FACILITY NUMBER:	019201202
ADMINISTRATOR:	BAUTISTA, HAIDIE		FACILITY TYPE:	740
ADDRESS:	1641-1659 D STREET		TELEPHONE:	(510) 397-0751
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	42	CENSUS: 38	DATE:	07/11/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Haidie Bautista/Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Facility is not providing adequate supervision to residents.

-Facility's Neighborhood Complaint Policy not followed.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegatiions. LPA was granted entry by staff, Sally Espina. LPA spoke over the phone with Haidie Bautista, administrator, and informed the reason for visit. Administrator arrived after about 35 minutes.

During the course of investigation, LPA reviewed residents' files, conducted interiews, and obtained copies of residents' records.

Allegation: Facility is not providing adequate supervision to residents.
Reporting parties (RP1, RP2) stated facility residents were throwing things to the neighbor's property, picking roses without the neighbor's permission, and wandering at night and early morning, and breaking into the neighbor's property.

......continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 15-AS-20230705170957

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: BELLA VISTA	FACILITY NUMBER: 019201202
	VISIT DATE: 07/11/2023

NARRATIVE

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

Reporting party (RP3) stated at least two or three of the residents are frequently seen wandering up and down the streets often muttering or yelling obscenities and occasionally throwing things. RP3 also stated that traffic cones and a small solar light from a neighboring yard hurled at RP3's screen door within the past two weeks.

LPA interviewed staff (S1 and S2) who stated R1 had behavior and recently was restless and sent out to John George. Both staff stated that R2 has been yelling and screaming. S1 stated they (staff) called Mobile Crisis when R1 exhibited restlessness behavior. Facility Notes confirmed S1 and S2 statements about R1 and R2's behaviors. The administrator stated residents can leave the facility unassisted which LPA confirmed upon review of Physician's Reports.

While at the facility, LPA observed R2's case manager interviewing resident (R2). Administrator stated that she spoke with the R2's case manager who said that R2 will be move-out within two weeks.

Allegation: Facility's Neighborhood Complaint Policy not followed.
Reporting party indicated that RP communicated the issues and concerns with the administrator and that the administrator is pushing back the meeting until the facility liaison who is currently out of the state is back. Review of RP's communication with the administrator confirmed the issues were brought up to the administrator, and administrator responded within 24 hours and offered monetary compensation for the damages. Record of communication between RP and administrator showed RP indicated RP wanted to contact directly the facility liaison who was at the time is still out of the state. LPA interviewed administrator who stated and confirmed the liaison is still out of state; however. she called the liaison on July 10, 2023, and informed about setting-up an appointment to meet with the reporting party.

Based on information gathered, the allegations of 'Facility is not providing adequate supervision to residents.' and 'Facility's Neighborhood Complaint Policy not followed. ' are closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted and copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2