019201373-7-10-2026-15-AS-BFOG-DWGTW3-20260730150452

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201373
Report Date: 07/10/2026
Date Signed: 07/10/2026 04:41:13 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
03/26/2026 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20260326120524

FACILITY NAME:	BELLARA SENIOR LIVING		FACILITY NUMBER:	019201373
ADMINISTRATOR:	COLLETTE VALENTINE		FACILITY TYPE:	740
ADDRESS:	22400 2ND STREET		TELEPHONE:	(510) 244-0949
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	175	CENSUS: 167	DATE:	07/10/2026
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Karren Melad/Resident Care Director and Jeff Sumabat/Executive Director		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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On this day, July 10, 2026, at 10:55 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegation and close the complaint. LPA met with Resident Care Director (RSD) Karren Melad and informed the reason for visit. LPA later met with Executive Director Jeff Sumabat.

It was reported that resident (R1) went to bed on 1/14/26 with gold chain and bracelet on and in the morning of 1/15/26, they were gone. R1’s family hired 1:1 caregivers for R1 during the day and when R1's 1:1 caregiver (W1) arrived that morning, W1 noticed R1 was not wearing the jewelry anymore.

....continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026

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 15-AS-20260326120524

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: BELLARA SENIOR LIVING	FACILITY NUMBER: 019201373
	VISIT DATE: 07/10/2026

NARRATIVE

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Two of the 5 residents stated they haven't lost anything since they moved-in, while 1 of the 5 stated she lost jelwery but may have lost them in the previous home before she moved-in. Another resident stated they lost jewelry and reported it was missing to the maintenance staff but there's no maintenance staff by the name provided by this resident. This resident stated having memory issue. One of the 5 residents stated they lost a particular item but this resident's family member (FM2) stated packing this resident's belonging when resident moved-out from other facility and move them to this facility but can not confirm whether or not the alleged missing item was brought in during move-in. Review of the residents' LIC621s showed no items listed.

Based on information gathered during the course of investigation and LPA unable to obtain information from R1 and W1 and no items listed on LIC621s, the allegation is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred.

No deficiency cited.

The Executive Director has to leave and stated Karren Melad will sign and receive this report.

Exit interview conducted and a copy of this report was provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260326120524

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: BELLARA SENIOR LIVING	FACILITY NUMBER: 019201373
	VISIT DATE: 07/10/2026

NARRATIVE

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During the course of investigation, LPA obtained copies of resident roster and staff schedule. LPA reviewed residents' records and obtained copies of including but not limited to LIC601 Identification and Emergency Contact Information, LIC602A Physician's Report and LIC621 Client/Resident Personal Property and Valuables. LPA conducted interviews and received from ED copy of incident reported to Hayward Police Department (HPD). LPA also obtained copy of report from HPD.

LPA interviewed the following: resident’s (R1) family member (FM1) on 3/30/26 and 4/01/26; staff (ED) on 4/01/26 and 4/22/26; staff (S2) on 4/22/26; staff (S4) on 6/02/26; staff (S3) on 6/16/26; staff (S1) on 4/01/26, 4/22/26 and 7/10/26; staff (S5, S6 and S7) on 7/10/26; residents (R4, R5, R6, R7 and R8) on 7/10/26; resident's family member (FM2) on 7/10/26.

FM1 stated W1 reported that R1 was wearing the jewelry when R1 went to bed on 1/14/26 and were gone when W1 came in the morning on 1/15/26.

ED stated that he reported the alleged theft to HPD. S1 stated when the items were reported missing, they searched R1’s apartment and didn’t find them.

One of the staff interviewed stated observing R1 wearing bracelet but not the necklace because every time this staff provide administration of medications to R1, R1 was wearing closed neck top. Three of the staff confirmed they were assigned to R1 and observed R1 wore jewelry but denied taking them. One of these staff who put R1 to bed on 1/14/26 after W1 left for the day stated observing R1 wearing only the call pendant but not the jewelry. S6 stated not seeing R1's jewelry and denied taking belongings of any residents. S7 stated no resident reported any missing item to this staff.

LPA made multiple phone calls to R1’s 1:1 caregiver (W1) on different dates but W1 did not respond nor return LPA’s call. LPA was unable to interview R1 as R1 was not in the facility when LPA conducted the initial investigation on 4/01/26 and no longer in the facility when LPA conducted subsequent investigation on 4/22/26.

.....continued on 9099C

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026

LIC9099 (FAS) - (06/04)

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