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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880645
Report Date: 06/03/2021
Date Signed: 06/03/2021 12:43:58 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/04/2020 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200904142916
FACILITY NAME:BELLA VILLAGGIOFACILITY NUMBER:
331880645
ADMINISTRATOR:WIERINGA, DIERDRE (DEE)FACILITY TYPE:
740
ADDRESS:40235 PORTOLA AVETELEPHONE:
(760) 607-5200
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:170CENSUS: 86DATE:
06/03/2021
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Jim Germyn, Executive DirectorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Facility staff do not provide proper care for residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tricia Danielson visited the facility to conclude a complaint investigation into the allegation listed above. LPA met with Executive Director Jim Germyn and discussed the purpose of the visit. Regarding the allegation "facility staff do not provide proper care for residents", it was alleged that the facility's memory care unit was short staffed resulting in dementia residents being left alone in the living room for long periods of time. It was also alleged that there were only two (2) staff for the whole memory care unit. The complaint further alleged that staff were unable to complete all of their chores which resulted in the staff rushing residents through their meals in order to complete their chores on time. Lastly, the complaint alleged that staff were required to work double shifts in order to meet staffing needs. Interviews conducted revealed five (5) of five (5) staff believed they did not have to rush residents through their meal times in order to be able to complete their duties each shift. All five (5) staff interviewed stated they do not and have not ever rushed a resident through their meal time in order to be able to completed their duties. All five (5) staff interviewed reported that each shift is regularly staffed with five (5) to six (6) staff. Five (5) of five (5) staff stated they are
(CONTINUED ON LIC 9099-C)
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Reyna Lacey
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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 18-AS-20200904142916
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BELLA VILLAGGIO
FACILITY NUMBER: 331880645
VISIT DATE: 06/03/2021
NARRATIVE
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(CONTINUED FROM LIC 9099)
able to completed their duties each shift without issue. Three (3) of five (5) staff interviewed stated they have worked overtime in the past for small quantities of time to help out but have not done double shifts. Six (6) residents were interviewed however, only one (1) was found to be a reliable historian. That one (1) resident
reported they are given adequate time to complete their meal and they do not feel rushed to finish their meal faster than they would like. LPA observed the memory care lunch meal service and did not observe any resident being rushed or hurried through the service. LPA also observed staff in numbers adequate to meet the needs of the residents. LPA did not observe any residents left alone without staff.

This agency has investigated the complaint alleging "facility staff do not provide proper care for residents". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with Executive Director Germyn and a copy of this report was provided.
SUPERVISORS NAME: Reyna Lacey
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2