331880645-6-20-2023-18-AS-KCLS-CSZMHV-20230621093808

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880645
Report Date: 06/20/2023
Date Signed: 06/20/2023 10:24:57 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2021 and conducted by Evaluator Rayshaun Nickolas

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210804114615

FACILITY NAME:	BELLA VILLAGGIO		FACILITY NUMBER:	331880645
ADMINISTRATOR:	JIM GERMYN		FACILITY TYPE:	740
ADDRESS:	40235 PORTOLA AVE		TELEPHONE:	(760) 607-5200
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY:	170	CENSUS: 136	DATE:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Eloiza Castellanos, General Manager		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff failed to provide proper care for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility announced to deliver the finding on the above allegation. LPA met with General Manager Eloiza Castellanos and explained the purpose of the visit. Department staff initiated the initial 10-day visit and collected pertinent information relevant to this investigation. LPA Nickolas reviewed evidence collected during the initial 10-day visit.

The allegation alleged that the facility is under staff. The allegation alleged that the residents waited 30 minutes after activating their call button to receive assistance because the facility was not sufficiently staffed. Department staff investigation revealed that 11 residents had private caregivers during the initial complaint investigation. LPA Nickolas reviewed the facility’s pendant response time report for the week of August 1, 2021, through August 10, 2021, for 33 caregivers. The report revealed that the caregiver’s average response time to the resident’s activated pendants was between 1 minute and 44 seconds and 13 minutes and 40 seconds, except for one (1) caregiver with an average response time of 32 minutes and 58 seconds.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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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Control Number 18-AS-20210804114615

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: BELLA VILLAGGIO	FACILITY NUMBER: 331880645
	VISIT DATE: 06/20/2023

NARRATIVE

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During today's visit, LPA Nickolas' requested a current copy the facility's employee roster and confirmed that the caregiver with an average response time of 32 minutes and 58 seconds, is no longer employed at this facility. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of unsubstantiated means that 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, and a copy of this report was provided.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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