019201202-12-19-2025-15-AS-BFOG-DTU273-20260506170803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201202
Report Date: 12/19/2025
Date Signed: 12/19/2025 02:24:51 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
12/15/2025 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20251215105533

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: 33	DATE:	12/19/2025
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Haidie Bautista/Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not prevent residents in care from engaging in inappropriate behaviors.

INVESTIGATION FINDINGS:

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At 10:25 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegation. LPA met with staff, Sally Espina. LPA called and spoke over the phone with Haidie Bautista, administrator (ADM), who arrived at 11:10 am.

It was reported that there were residents harassing other residents asking for money and cigarettes and residents exposing their private parts to others and walk naked. It was also alleged that a resident urinates outside the facility.

LPA obtained copies of resident roster and staff schedule, and reviewed resident record. LPA also reviewed the Unsual Incident Report and SOC341 submitted by ADM to LPA on 12/15/25. LPA interviewed 3 staff and 3 residents.

....continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20251215105533

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: 12/19/2025

NARRATIVE

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All of the staff and residents interviewed including administrator stated not observing resident exposed self nor walk naked. They did not observed anyone urinates outside the facility.

All 3 residents stated no one borrow money from them. One of these residents stated a resident borrowed cigarettes from him but it was his fault giving that resident. Two of the staff stated not hearing residents borrowed money from other residents while the other staff stated it is the residents' behavior borrowing money and cigarettes from each other. If this staff hears a resident borrows money from other resident, she tells the resident to wait for their money which comes every two weeks. ADM stated residents borrow money and cigarettes and does not think they feel harassed because it's their mutual behaviors.

Based on information obtained, 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 a copy of this report was provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC9099 (FAS) - (06/04)

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