019201202-7-10-2025-15-AS-HHUL-DK2NMW-20250729103547

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201202
Report Date: 07/10/2025
Date Signed: 07/10/2025 03:26:30 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
04/17/2025 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20250417163152

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: 37	DATE:	07/10/2025
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Haidie Bautista/Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff (S1) sexually abused resident (R1).

INVESTIGATION FINDINGS:

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On this day, July 10, 2025, at 2:30 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegation. LPA met with Haidie Bautista, administrator (ADM), and informed the reason for visit.

The reporting party (RP) stated that on 4/15/2025, resident (R1) told RP that on 4/15/2025, staff (S1) assisted R1 with showering. Afterwards, while R1 was naked, S1 rubbed down R1’s back, turned R1 around, French kissed R1 and put his erect private part against R1’s body.

...........continiued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

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-20250417163152

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: 07/10/2025

NARRATIVE

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During the course of investigation, the Department obtained copies of LIC9020 Register of Facility Clients/Residents, staff roster and LIC624 Unusual Incident Report concerning resident (R1). Copies of R1’s following documents were also obtained: LIC602A Physician's Report; Preplacement Appraisal; LIC625 Appraisal/Needs and Services Plan; LIC9172 Functional Capability Assessment. Local law enforcement was also involved in the investigation and copy of police report was obtained and reviewed.

The following were interviewed: RP on 6/09/25; staff (S2, S3, S4) and administrator (ADM) on 6/10/25; residents (R2, R3, R4) on 6/10/25; resident (R1) on 6/16/25; staff (S1) on 6/19/25.

RP confirmed what R1 reported to RP. RP stated that R1 told RP about S1 telling R1 not to tell anyone what had happened. S1 asked R1 for R’s phone number as S1 said he was leaving the facility and wanted to keep in contact with R1 but R1 did not provide S1 with R1’s phone number.

R1 was inconsistent with her statement to the Department. R1 stated that S1 gave R1 “a quick kiss” only and that there was no other inappropriate touching, and no part of S1’s body parts touched R1’s back. The Hayward Police Department closed their case due to R1 not wanting to make a statement.

S1 denied all allegations of inappropriate touching. S1 stated he has showered and dried R1 multiple times without incident. S1 further stated that he has never said or done anything to upset R1 that would prompt this type of allegation, did not notice any changes in R1’s behavior during the week of the alleged incident, and R1 has never indicated that R1 was uncomfortable around him.

The staff and residents interviewed said they never saw S1 act unusual or inappropriate around residents or R1. There were no staff or residents who could have witnessed the incident.

The information gathered during investigation did not confirm the allegation, therefore the complaint is closed as unsubstantiated. A finding that a complaint is unsubstantiated means that there is not a preponderance of evidence to prove that the allegation and violation occurred.

No deficiency cited. Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

LIC9099 (FAS) - (06/04)

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