019201202-3-11-2026-15-AS-BFOG-DSXMBU-20260408092831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201202
Report Date: 03/11/2026
Date Signed: 03/11/2026 06:49:58 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
10/07/2025 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20251007084713

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: 40	DATE:	03/11/2026
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Haidie Bautista/Administrator		TIME COMPLETED:	06:55 PM

ALLEGATION(S):

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Physical abuse of resident while in care.

Verbal abuse of resident while in care

INVESTIGATION FINDINGS:

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On this day, March 11, 2026, Licensing Program Analyst (LPA) Delmundo arrived unannounced to 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 resident's records and obtained copies of including but not limited to LIC602A Physician's Report, Unsual Incident Reports (UIRs), hospital After Visit Summaries, SOC341. LPA interviewed the following: staff (S2, S3, S4, S5 and ADM) and resident (R3) on 10/08/25; residents (R2, R4, R5) and staff (S1, S6) on 11/04/25; staff (S7) on 12/19/25.

Allegation: Physical abuse of resident (R1) while in care.
Allegation: Verbal abuse of resident (R1) while in care.

....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)

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Control Number 15-AS-20251007084713

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 October 2025, the reporting party (RP) stated that R1 reported a staff, S1, had punched R1 in the head with closed fist two times and grabbed the neck of R1's shirt and pulled R1. R1 further reported that S1 yelled at R1 and threatened to "beat him up".

The administrator (ADM) stated that one of the staff reported to her that a police officer came due to the reported abuse. S1 was interviewed by the police officer and asked if R1 went out and fell outside the facility and interviewed S1 regarding the alleged abuse which S1 denied. ADM submitted a copy of SOC341 to the Department. SOC341 also indicated that on 9/22/25, R1 was 5150'd due to pulling of the hair of one of the staff.

S1 denied the allegation. He stated the police officer came and he was not aware there's a complaint by R1 against him. He was asked if R1 went out that day and he told the police officer he does not know, because the residents can leave the facility. There were times when R1 left the facility at night and tell other residents when he leaves and S1 did room check. He was also asked if he ever hit R1 and he said he never did and that he's here to assist the residents. The other staff interviewed stated not observing S1 being physically and/or verbally abusive to R1. Some of these staff stated it is them who are at times hit by residents.

The 4 residents (R2, R3, R4 and R5) stated not observing staff including S1 being physically and verbally abusive to R1. They stated S1 is a good staff.

Review of 3 Unusual Incident Reports (UIRs) for incidents that happened on October 2025 showed R1 had 2 unwitnessed falls and an episode of seizure where R1 was sent out to the hospital. The hospital After Visit Summaries confirmed the incidents and one of these documents showed R1 sustained laceration of the scalp
Based information gathered and due to R1 was no longer at the facility when LPA began the investigation, the above 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)

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