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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201202
Report Date: 03/11/2026
Date Signed: 03/11/2026 06:29:52 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, 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
03/05/2026 and conducted by Evaluator Alicia Delmundo
COMPLAINT CONTROL NUMBER: 15-AS-20260305094639
FACILITY NAME:BELLA VISTAFACILITY NUMBER:
019201202
ADMINISTRATOR:BAUTISTA, HAIDIEFACILITY TYPE:
740
ADDRESS:1641-1659 D STREETTELEPHONE:
(510) 397-0751
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:42CENSUS: 40DATE:
03/11/2026
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Haidie Bautista/AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not ensure resident's information was kept confidential.
INVESTIGATION FINDINGS:
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On this day, March 11, 2026, at 10:35 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegation. LPA met with House Manager Sally Espina and informed the reason for visit. Haidie Bautista, administrator (ADM) arrived at around 11:05 am.

It was alleged that staff, S1, told resident's (R1) medications to R1's roommate (R2).

LPA reviewed residents' records and obtained copies of the following: LIC601 Identification and Emergency Contact Information; LIC602A Physician's Report; R1's doctor's order of medication. LPA also reviewed Unusual Incident Report (UIR) submitted by ADM. LPA interviewed staff (S1, S2, S3 and ADM) and residents (R1, R2).

.......continued on 9099C
Unfounded
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)
Page: 1 of 2
Control Number 15-AS-20260305094639
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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The administrator (ADM) stated she received a call from R1's case manager (CM) regarding the allegation. ADM further stated that upon knowledge, she conducted investigation. S1 denied the allegation and that R1 and R2 stated that S1 didn't share R1's medications information.

S2 and S3 stated never hearing S1 disclosed personal information nor R1's medications to others. S1 denied the allegation.

Both R1 and R2 stated S1 never shared nor disclosed personal or medication information to others.

Based on records review and interviews, the allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis, therefore, the complaint is dismissed.

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)
Page: 2 of 2