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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201202
Report Date: 03/11/2026
Date Signed: 03/11/2026 06:44:29 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
09/29/2025 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20250929145917
FACILITY NAME:BELLA VISTAFACILITY NUMBER:
019201202
ADMINISTRATOR:BAUTISTA, HAIDIEFACILITY TYPE:
740
ADDRESS:1641-1659 D STREETTELEPHONE:
(510) 397-0751
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:42CENSUS: 40DATE:
03/11/2026
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Haidie Bautista/AdministratorTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Staff do not ensure residents' privacy.

Staff are not meeting residents' dietary needs.

Staff do not ensure residents are accorded dignity.
INVESTIGATION FINDINGS:
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On this day, March 11, 2026, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation and deliver the findings for the above allegations. LPA met with Haidie Bautista, administratot (ADM), and informed the reason for visit.

During the course of investigation, LPA reviewed residents’ records and obtained copies of including but not limited to LIC601 Identification and Emergency Information, LIC602A Physician's Report, LIC625 Appraisal/Needs and Services Plan. LPA also obtained copies of menu, LIC9020 Register of Clients/Residents and staff schedule, and inspected the food supplies. LPA interviewed the following: staff (S1, S2, S3, S4, S6) on 10/08/25; resident (R1) on 10/07/25 and 11/04/25; residents (R2, R3) on 10/08/25; residents (R5, R6) and staff (S5) on 11/04/25; staff (S7) on 11/04/25 and 3/11/26.

....continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026
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 3
Control Number 15-AS-20250929145917
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: 03/11/2026
NARRATIVE
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Allegation: Staff do not ensure resident’s privacy.
The reporting party (RP) stated that at night around September 2025, resident (R1) was going to the big building in the facility to take a shower, and R1 observed staff (S2) giving bath to resident (R2). R2 was naked and the bathroom door was open while S2 was giving R2 a bath.

All residents except R1 stated not observing any staff giving bath to residents with bathroom door open. R1 stated observing S2 giving bath to R2 one night with bathroom door open.

One of the staff does not provide care giving while the other one stated not providing assistance with bathing to residents. S2 who works NOC shift stated he does not give bath to residents including R2 at night and that residents are given bath during the day. The rest of the staff interviewed indicated when they provide assistance with bathing they close the bathroom door. Due to medical condition, LPA was not able to obtain information from R2. Therefore, the allegation is close as unsubstantiated.

Allegation: Staff are not meeting residents’ dietary needs.
The reporting party (RP) stated R1 has been forced to eat meat but due to religion, R1 cannot eat meat or use animal products due to R1 itches when eating and/or touching animal products.

Review of records showed R1 was seen by a doctor due to itching but After Visit Summary didn’t indicate to avoid and/or not eat animal products. LIC602A Physician’s Report didn’t indicate any food allergies or other type of allergies.

On 10/07/25, R1 stated that when he moved-in, he told the staff that he prefers vegetarian food but he turned vegan around 10/2025, because whenever he eats something with meat and meat bi-products, he itches. At first, the staff told him 'maybe' and later was offered vegetarian diet but it's not totally vegetarian because they still put meat on it. Around first week of October 2025, the cook told him he can buy his own food and the cook will prepare for him but S7 told him that he should not be bothering the cook which S7 denied telling R1. ........continued on 9099C
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20250929145917
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: 03/11/2026
NARRATIVE
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On 11/04/25, R1 stated the staff are good and serving him vegetarian meals.

LPA conducted inspection of the kitchen and observed list of residents who are on soft diet and those with food preference but no list of residents who are vegetarian or vegan. The cook stated he does not have list but he knows because there's only 2 of them. He stated R3 is vegetarian due to religious/spiritual belief and he does not serve R3 meat. He further stated that he himself is vegetarian, so whatever he prepares for himself, he serves to R3. He also stated that R1 use to eat meat before but around September 2025, R1 transitioned to vegan. On November 2025, R1 told him that he's not eating meat so he prepared him vegetarian meals for about 5 days, but after 5 days, R1 told him that vegetarian diet is not working, so R1 started eating meat again and asked him for hot dog. When R1 told him he is vegan, he served him vegan meals.



R3 stated staff do not served him meat.

Based on interviews and records review, the allegation is unsubstantiated.

Allegation: Staff do not ensure residents are accorded dignity.
The reporting party (RP) stated that when staff (S3) was putting 'apron' on resident's (R2) thigh while in the dining room during meal, S3 touched R2's thigh and was not mindful. R1 stated it bothered him and does not think that the touching was accidental. S3 confirmed she puts an apron like a bib and ties it on R2's neck and the apron stretches up to the lap. S3 denied touching R2's thigh when placing the apron. Due to medical condition, LPA was not able to obtain information from R2. Therefore the allegation is unsubstantiated.

Based on interviews, records review and inspection, the 3 allegations are unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiency cited. Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3