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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880645
Report Date: 11/18/2021
Date Signed: 11/18/2021 03:44:29 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2021 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211110141302
FACILITY NAME:BELLA VILLAGGIOFACILITY NUMBER:
331880645
ADMINISTRATOR:JIM GERMYNFACILITY TYPE:
740
ADDRESS:40235 PORTOLA AVETELEPHONE:
(760) 607-5200
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:170CENSUS: 109DATE:
11/18/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jim Germyn - General ManagerTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff are not assisting with resident incontinence.

Staff are not meeting the needs of the residents.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Crystal Colvin and Venus Mixon arrived at the facility unannounced in order to initiate an investigation of a complaint with the above allegation(s). LPAs identified themselves and discussed the purpose of the visit and the elements of the allegation(s) with General Manager Jim Germyn. Below is a summary of the complaint investigation findings:

Regarding allegation "Staff are not assisting with resident incontinence": LPAs interviewed residents, staff, and other persons who would have information regarding the care of residents regarding these allegations. Interviews conudcted did not provide any evidence to suggest that residents are not assisted with their toileting needs. Additionally, no specific information other than a single resident's first name was provided in the complaint, and no evidence, dates, or other information was included. Therefore, based on lack of evidence and information as well as interviews conducted, the allegation of "Staff are not assisting with resident incontinence." is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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 18-AS-20211110141302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BELLA VILLAGGIO
FACILITY NUMBER: 331880645
VISIT DATE: 11/18/2021
NARRATIVE
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Regarding allegation "Staff are not meeting the needs of the residents.": LPAs interviewed residents, staff, and other persons who would have information regarding the care of residents regarding these allegations. Interviews conducted did not provide any evidence to suggest that residents are not assisted with their needs. No complaints regarding needs being met and there was no observable deficiencies present during today's inspection. Additionally, no specific information other than a single resident's first name was provided in the complaint, and no evidence, dates, or other information was included. Therefore, based on lack of evidence and information as well as interviews conducted, the allegation of "Staff are not meeting the needs of the residents." is UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted with General Manager Jim Germyn and a copy of this report was provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2