331881395-7-9-2025-18-AS-JDHS-DJMVGL-20250716162542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881395
Report Date: 07/09/2025
Date Signed: 07/09/2025 01:38:16 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
05/13/2025 and conducted by Evaluator Armando Perez

COMPLAINT CONTROL NUMBER: 18-AS-20250513163257

FACILITY NAME:	BELLA CASA 3		FACILITY NUMBER:	331881395
ADMINISTRATOR:	CARLOS, ROMMEL; URSULA		FACILITY TYPE:	740
ADDRESS:	77583 CARINDA COURT		TELEPHONE:	(760) 772-5089
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92211
CAPACITY:	6	CENSUS: 6	DATE:	07/09/2025
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Administrator		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Staff are isolating resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Armando Perez, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA met with Administrator, Ursula Carlos, where the LPA explained the purpose of the visit and the elements of the allegation. The investigation consisted of interviews with staff and residents, observations, and file review.

On May 13, 2025, Community Care Licensing received a complaint alleging that staff was isolating Resident #1 (R1). It was reported that R1 was not permitted to communicate with family and friends via telephone and was confined to their room. It was also reported that R1 stated they felt like a prisoner at the facility. Information obtained from an interview with Administrator stated that facility staff offer a range of activities aimed at keeping residents engaged and physically active. During the interview, Administrator denied any instances of staff isolating residents and stated there were no concerns of any resident feeling isolated or not participating in scheduled activities.
Continued on LIC 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025

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 18-AS-20250513163257

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BELLA CASA 3	FACILITY NUMBER: 331881395
	VISIT DATE: 07/09/2025

NARRATIVE

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Information obtained from interviews with additional staff stated that R1 does actively participate in activities and has not advised of any concerns or issues. However, an interview with R1 revealed they did not feel isolated or neglected by staff. R1 reported no complaints or issues about staff conduct. R1 does not remember stating that they felt like a prisoner at the facility. R1 further stated received a new cell phone, but was having difficulty utilizing it. R1 stated they could place calls independently, but also requested and received staff assistance when needed. Additional interviews with residents confirmed they did not feel isolated or neglected by staff. Residents also reported that staff provide a range of activities, including walking exercises, art sessions, and social engagements. All interviewed residents stated they had not been denied access to phone or mail services while residing at the facility. During an interview with an additional witness, information was advised that there are no concerns with R1 being neglected or isolated. It was stated that R1 actively participates in activities. It was confirmed that R1 received a new phone and there was difficulty working the phone. Additional Witness state there is no concerns with being able to contact R1. Although the facility did not maintain an activities log, a file review was conducted, and case notes indicated that R1 was participating in activities.

Based on interviews, research, and record review, the allegation that staff are isolating resident in care is unfounded. A finding that the allegation is unfounded meaning that the allegation was false, could not have happened, and/or is without a reasonable basis. Therefore, this complaint is dismissed.

An exit interview was conducted. A copy of this report was provided to Administrator Ursula Carlos.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025

LIC9099 (FAS) - (06/04)

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