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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006068
Report Date: 06/28/2023
Date Signed: 06/28/2023 05:27:34 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2023 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230628094002
FACILITY NAME:BELLA CLARE HOME 2FACILITY NUMBER:
306006068
ADMINISTRATOR:JOSHUA ESTREVILLOFACILITY TYPE:
735
ADDRESS:6892 SAN PADRE CIR.TELEPHONE:
(714) 723-6780
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:4CENSUS: 2DATE:
06/28/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Joshua Estrevillo - AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator failed to report verbal abuse.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jerome Haley made unannounced visit in regards to the complaint allegation above. Upon arrival staff called Administrator (AD) Joshua Estrevillo via telephone who arrived a short time later and was present for the visit. LPA Haley discussed the reason for the visit with AD Estrevillo.

During the visit, LPA Haley interviewed AD Estrevillo, Staff 1(S1), and attempted interviews with client 1 (C1), and client 2 (C2) regarding the complaint allegation. During the investigation, interviews were conducted with witnesses who strongly denied the complaint allegation.

Based on the information gathered during the investigation, conflicting information provided during interviews, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.
An exit interview was conducted, and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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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