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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880645
Report Date: 11/23/2025
Date Signed: 11/23/2025 02:53:46 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
06/23/2021 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 18-AS-20210623121750
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: 92DATE:
11/23/2025
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Kimberly PedrosaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not address a resident's toileting needs while in care
Resident was left soiled while in care
Resident sustained an injury from a fall while in care
Resident was charged for services not received
INVESTIGATION FINDINGS:
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In conjunction to complaint control #18-AS-20220923161355, Licensing Program Analyst (LPA) Michael Cava also conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. LPA met with the Business Manager (BM), Kimberly Pedrosa, and advised her of the complaint. The ten day visit was made by LPA Stephanie Torres on 07/02/21. Today's investigation consisted of of interviews with the BM, staff and residents. A physical plant inspection and record review was also conducted.

Staff did not address a resident's toileting needs while in care/Resident was left soiled while in care:
In regards to the allegation, it was reported that on or around April 11, 2021, Resident 1 (R1) was observed sitting on their own feces. Feces was also observed on R1's bathroom and recliner. This wasn't the first time similar incident like this had occurred. It was reported that on or around May 4, 2020, feces was also observed smeared on R1s toilet seat. LPA attempted to contact the reporting party several times to obtain
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2025
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-20210623121750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BELLA VILLAGGIO
FACILITY NUMBER: 331880645
VISIT DATE: 11/23/2025
NARRATIVE
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and confirm the allegation, and to also identify any witnesses, but there was no reply. Between 9:20am to 10:20am, interviews with the BM and three (3) of three staff deny the allegation. Between 10:20am and 11:20am, interviews with ten (10) of ten residents expressed no complaints or concerns regarding of their needs not being met. Between 11:20am to 12:00pm, LPA conducted a physical plant inspection, and observed sufficient staff monitoring the floors during the visit.

Based on the information obtained, there was insufficient evidence to prove that staff do not address a resident's toileting needs while in care or a resident being left soiled while in care. Therefore, the allegation is deemed Unsubstantiated at this time.

Resident sustained an injury from a fall while in care:
In regards to the allegation, it was reported that on or around April 21, 2021, R1 had a fall at about 6:30 in the evening attempting to go to the bathroom. R1 was transported to the hospital and was placed in ICU for four days, with a traumatic brain injury. There are no call buttons for the elderly and limited mobility residences to get help. After several attempts to contact the reporting party, LPA was unable to obtain additional information to corroborate with the allegation. Between 9:20am to 10:20am, interviews with the BM and three (3) of three staff deny the allegation. Between 10:20am and 11:20am, interviews with ten (10) of ten residents expressed no complaints or concerns regarding of their needs not being met.

Based on the information obtained, there was insufficient evidence to prove the allegation of R1 sustaining an injury from a fall while in care. Therefore, the allegation is deemed Unsubstantiated at this time.

Resident was charged for services not received:
In regards to the allegation, it was reported that the additional pay that was charged for R1 for additional care and supervision to include physical assistance with toileting was not met. After several attempts to contact the reporting party, LPA was unable to obtain additional information to corroborate with the allegation. Between 9:20am to 10:20am, interviews with the BM and three (3) of three staff deny the allegation. Between 10:20am and 11:20am, interviews with ten (10) of ten residents expressed no complaints or concerns regarding of their needs not being met.

Based on the information obtained, it could not be proven that a resident was charged for services not received. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2