496803536-10-21-2021-21-AS-KMOA-C86QNX-20211026121952

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803536
Report Date: 10/21/2021
Date Signed: 10/21/2021 10:56:48 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2021 and conducted by Evaluator Erik Gonzalez Campos

COMPLAINT CONTROL NUMBER: 21-AS-20210526100132

FACILITY NAME:	BELLA VISTA VILLAGE		FACILITY NUMBER:	496803536
ADMINISTRATOR:	VEGVARY, JULIUS & MERCEDES		FACILITY TYPE:	740
ADDRESS:	18941 SONOMA HWY		TELEPHONE:	(707) 483-0998
CITY:	SONOMA	STATE: CA	ZIP CODE:	95476
CAPACITY:	12	CENSUS: 9	DATE:	10/21/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Licensee, Mercedes Vegvary		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Unlawful eviction of resident
Personal Rights

INVESTIGATION FINDINGS:

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The Department conducted a complaint investigation regarding the allegations listed above. Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 10/21/2021 for the purpose of delivering findings of the above allegations. LPA met with Mercedes Vegvary, Licensee.

There is an allegation of an unlawful eviction of resident. According to Licensees, R1 had not paid the first three months and documentation generated by Licensees attorney reflects rent for November 2020-March 2021 was not completely paid. Complainant alleges responsible party for R1 did not find out about the eviction until May of 2021. Attorney’s office provided certified U.S. postal receipt addressed to responsible parties at a P.O. Box address on 3/15/2021. Responsible party was interviewed on 9/2/2021 and acknowledged they were aware R1 was behind in their rent in January of 2021. Responsible party also shared R1 had passed away and indicated they had wanted to move R1 to a smaller facility closer to R1’s family. Reporting party provided attestation that Licensee did not tell R1 they were being evicted.
Continued on LIC 809C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez Campos	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

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 21-AS-20210526100132

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: BELLA VISTA VILLAGE	FACILITY NUMBER: 496803536
	VISIT DATE: 10/21/2021

NARRATIVE

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Letter regarding eviction dated 3/15/2021 and 5/18/2021 were mailed to R1 at the facility address. Interview with Licensee on 8/2/2021 revealed they had talked to R1 about being evicted. Although the allegation may be valid, there is not a preponderance of evidence to prove the alleged violations did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED.

There is an allegation of personal rights regarding a lien being placed on R1s property upon admission. R1s admission agreement was signed 12/25/2016 and a deed was signed on 10/30/2016 by R1. The purpose on the lien was to secure payment for care due to insurance date becoming effective after admission date. R1 was own responsible party, R1 continued to accrue a balance due to non-payment or payment not in full. Eviction notice was given with legal representation on behalf of the Licensee. R1 was relocated by responsible party and outstanding balance paid by Title Company on 5/21/2021 after the sale of R1s property. The Department obtained Title Company documents, Deed signed 10/2016 and documentation pertaining to the eviction. A cross report was made to Adult Protective Services (APS) regarding suspected elder abuse on outside party assisting R1. Although the allegation may be valid, there is not a preponderance of evidence to prove the alleged violations did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez Campos	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC9099 (FAS) - (06/04)

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