374604846-3-25-2026-08-AS-APAO-DT774C-20260415211941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604846
Report Date: 03/25/2026
Date Signed: 03/25/2026 11:41:32 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/17/2026 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20260317102636

FACILITY NAME:	BELLAHOMECARE III		FACILITY NUMBER:	374604846
ADMINISTRATOR:	COOK, CHERRY		FACILITY TYPE:	740
ADDRESS:	164 OLD RANCH RD		TELEPHONE:	(406) 998-8022
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	6	CENSUS: 6	DATE:	03/25/2026
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Cherry Cook		TIME COMPLETED:	11:45 PM

ALLEGATION(S):

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Staff did not maintain facility free from hazard for residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit and also delivered complaint findings. LPA introduced himself and disclosed the purpose of the visit with Administrator Cherry Cook.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA observations, records review, interviews with staff, residents and outside sources.

On March 25, 2026, Licensing Program Analyst (LPA) arrived at the facility to investigate the allegation that staff did not maintain the facility free from hazards for residents in care. The concern reported was that an outside source visited the facility to drop off supplies and observed a ramp in the common area/living room that was missing handrails. The outside source stated that they fell on the ramp and fractured their leg because the ramp had no handrails.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

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 08-AS-20260317102636

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BELLAHOMECARE III	FACILITY NUMBER: 374604846
	VISIT DATE: 03/25/2026

NARRATIVE

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During the visit, LPA observed the ramp in the living room/common area where the television is located. The ramp measured approximately 5 inches high, 92 inches wide, and 55 inches long. At the time of the visit, all residents present were ambulatory, with the exception of one resident. LPA asked each resident to walk up and down the ramp to observe whether the ramp created a safety issue.

Resident 1 walked up and down the ramp without any issues or visible difficulty. R1 told LPA, in Spanish, that they had no problems or concerns using the walkway. Resident 2 also walked up and down the ramp without difficulty. R2 stated they had no problems ambulating on the ramp and mentioned they sometimes use a walker but have never had trouble going up or down the living room walkway. Resident 3 used their walker to go up and down the ramp, also without any issues or signs of distress. R3 stated they have never had any problems using the walkway.

LPA interviewed an outside source who regularly visits Resident 4, who is non ambulatory. The outside source stated they have never had any issues or concerns when using the living room walkway during visits. LPA then interviewed Staff 1, who stated they have never witnessed or heard of any residents falling or tripping on the ramp.

LPA also interviewed the administrator, who reported that approximately two weeks prior, a delivery person arrived to drop off a printer. The administrator stated that the delivery person tripped while walking down the ramp. Facility staff provided first aid, and the delivery person declined 911 services. The administrator explained that the individual then continued to carry in two heavy printers. Later, the delivery person called the administrator and reported that they had gone to the emergency room due to the injury. The administrator stated they have never witnessed or received reports of any resident or staff member tripping or falling on the walkway ramp.

Based on observations, resident interviews, staff interviews, and information obtained during the investigation, there is not enough evidence to prove that the facility failed to maintain a hazard free environment for residents in care. Although an outside source reported an injury, there were no reports of residents experiencing issues with the ramp, and LPA did not observe any hazards affecting residents during the visit. Therefore the complaint is unsubstantiated. An exit interview was conducted with Cherry Cook. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Cherry Cook, whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

LIC9099 (FAS) - (06/04)

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