019201202-3-25-2025-15-AS-BFOG-DKXK4Q-20250827073443

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201202
Report Date: 03/25/2025
Date Signed: 03/25/2025 06:35:41 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
03/17/2025 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20250317093549

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: 34	DATE:	03/25/2025
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Haidie Bautista/Administrator and Sally Espina/House Manager		TIME COMPLETED:	06:40 PM

ALLEGATION(S):

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-Facility staff are not providing quality meals to residents.

-Facility staff are restricting resident's telephone use.

-Facility staff are restricting resident's leisure time activities.

INVESTIGATION FINDINGS:

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On this day, 3/25/25, Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegations. LPA met with House Manager Sally Espina. LPA called and spoke with Haide Bautista, administrator (ADM), and informed the reason for visit. ADM arrived after about 30 minutes.

During the course of investigation, LPA conducted inspection with staff and ADM, obtained copies of menu and LIC9020 Register of Facility Clients/Residents. LPA interviewed staff (S1, S2, S3, S4, S5 and ADM) and residents (R1, R2, R3). Residents (R4 and R5) refused to be interviewed.

Allegation: Facility staff are not providing quality meals to residents.
Reporting party (RP) stated observing nutritional foods being prepared by staff like chickens, vegetables, etc, but the meals that are given to the resident are as follows: Breakfast: a bowl of cold cereal. Lunch: cold hotdog or corn dog and a small bowl of soup. Dinner: ramen with vegetables
..........continued on 9099C (page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025

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 15-AS-20250317093549

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: 03/25/2025

NARRATIVE

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All 5 staff interviewed provided information on food/meal serve which were of different varieties. They serve corn dog only once or 2x a week. One out 3 residents interviewed provided information consistent with the information provided by the staff. One of the other resident stated food served is always good while the other one does not remember but not have issues/problems on the meals provided. Two other residents refused to be interviewed. ADM stated she does the grocery shopping online of different varieties from different grocery chains and whatever is not available she asks one of the staff to do in-person grocery shopping. LPA inspected the food supplies and copies of menus showed different varieties.

Based on inspection and interviews and LPA unable to obtain information from 2 residents, the allegation is closed as unsubstantiated.

Allegation: Facility staff are restricting resident's telephone use.
LPA conducted inspection and observed both buildings with land line telephones. All 5 staff stated the residents are allowed to use the facility telephone. Two of these staff and ADM stated that for courtesy to other residents who also want to use telephone, they tell the residents to limit their calls to 10 minutes but they can come back to use the telephone again. One of the 5 staff and ADM also stated that the facility also gets incoming calls and at times may need to make emergency calls.

One of the 3 residents stated not using the facility telephone because this resident has cell phone. The other 2 residents stated they are allowed to use and not told to limit their calls. The other 2 residents refused to be interviewed.

Based on interviews, the allegation is unsubstantiated.

Allegation: Facility staff are restricting resident's leisure time activities.
RP stated that all electrical devices such as TV, radio, etc, have to be off at 9:00 p.m. to save electricity, even if they are used with a headset.

.....continued on 9099 (page 3)

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 15-AS-20250317093549

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: 03/25/2025

NARRATIVE

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During inspection, LPA observed residents in both buildings watching TV, while others doing activities coloring book in the dining area. All 5 staff interviewed stated residents are allowed to watch TV as they want. The TV is turned off at night when observed no resident is watching. ADM denied telling the residents to turn off the TV, radio or other electrical device at 9:00 pm to save on electricity. She only tells them to turn down and/or use headset.

One out of 3 residents stated they are allowed to watch tv and staff ask to turn off at 8:00 pm but this resident stated still watches TV after 8:00 pm. One of these 3 stated residents are required to turn off the TV at 8:00 pm which is okay with this resident. The other resident stated staff allow them to watch as they want. LPA tried to interview the other 2 residents but they refused. Therefore, the allegation is unsubstantiated.

Based on interviews and observation during investigation, the allegations are closed as 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: 03/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025

LIC9099 (FAS) - (06/04)

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