331880645-5-20-2022-18-AS-EMAN-CHFM52-20220819091738

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880645
Report Date: 05/20/2022
Date Signed: 05/20/2022 02:30:49 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
06/29/2020 and conducted by Evaluator Jennifer Semin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200629132728

FACILITY NAME:	BELLA VILLAGGIO		FACILITY NUMBER:	331880645
ADMINISTRATOR:	WIERINGA, DIERDRE (DEE)		FACILITY TYPE:	740
ADDRESS:	40235 PORTOLA AVE		TELEPHONE:	(760) 607-5200
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY:	170	CENSUS: 137	DATE:	05/20/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Roxanne Cerrasco		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Resident had multiple falls in the facility resulting in injuries..
Staff left resident on the toilet for extended period of time.
Staff do not provide proper care for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Semin conducted an unannounced visit to the facility to deliver the findings for the above complaint allegations. LPA met with Health and Wellness Director Roxanne Cerrasco.
The investigation consisted of interviews and review of pertinent documents. Regarding the first allegation, Resident had multiple falls in the facility resulting in injuries. Relevant Party stated Resident 1 (R1) has had multiple falls with injuries due to lack of staff presence. Interviews with Staff and R1 revealed R1 has had multiple falls, but they did not result in injuries. Staff stated on one occasion, R1 did get a skin tear on their arm. The documents reviewed were consistent with the falls with no injuries.
Regarding the second allegation, Staff left resident on the toilet for extended period of time. Interviews with Staff and R1 revealed staff do not leave R1 on the toilet for extended periods of time. Staff stated they check on R1 periodically during toileting but occasionally R1 will attempt to get up without staff present. R1 stated staff are asked to leave and return upon being called. R1 stated staff check on R1 often and do not leave R1 for extended periods of time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer Semin	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

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-20200629132728

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: 05/20/2022

NARRATIVE

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Regarding the third allegation, Staff do not provide proper care for resident. RP stated R1 is not being provided services such as hygiene, grooming and topical treatment. Interviews with Staff and R1 revealed staff are providing R1 with all the services outlined in the admission agreement.
Based upon interviews and information gathered, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.
An exit interview was conducted where this report was discussed and provided to Ms. Cerrasco.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer Semin	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

LIC9099 (FAS) - (06/04)

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