18 Reports
Inspection Report — Mar 11, 2026
Complaint Investigation
Date: Mar 11, 2026
Visit Reason
The inspection was conducted as an investigation of a complaint regarding medication administration at the facility.
Complaint Details
Complaint Control # 15-AS-20260305094639 was investigated and substantiated by the finding of a medication record discrepancy.
Findings
The investigation found a discrepancy in a resident's medication record where one tablet remained despite the medication being administered three times daily since the start date. Staff could not explain the remaining tablet, indicating a potential recording error.
Citations (1)
CCR 87506(a) Resident Records: The licensee failed to maintain a complete and accurate resident record as evidenced by a medication discrepancy posing potential health and personal rights risks to the resident.
Report Facts
Plan of Correction Due Date: Mar 25, 2026
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Haidie Bautista | Administrator | Discussed medication discrepancy and plan of correction |
| Alicia Delmundo | Licensing Program Analyst | Conducted inspection and documented findings |
| Bennett Fong | Licensing Program Manager | Named in report header and deficiency section |
Inspection Report — Nov 4, 2025
Annual Inspection
Date: Nov 4, 2025
Visit Reason
The inspection was an unannounced annual inspection conducted to evaluate compliance with licensing requirements at the Bella Vista facility.
Findings
The inspection found some deficiencies related to unsafe storage of items such as saline solution, chest rub, nail polish remover, and yard tools, as well as medication administration errors involving a resident's medication dosage and missing medications. Other areas such as fire safety equipment, food supplies, and disaster preparedness were satisfactory.
Citations (2)
CCR 87309(a) Storage Space and Access: The licensee did not secure disinfectants, cleaning solutions, and tools, including saline solution, chest rub, nail polish remover in residents' rooms, and shovels and rakes in the yard, posing immediate health and safety risks.
CCR 87565(c)(2) Incidental Medical and Dental Care: The licensee failed to have some of resident R2's medications and administered an incorrect dosage for one medication, posing immediate health and personal rights risks.
Report Facts
Liability insurance: 3000000
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Haidie Bautista | Administrator | Named in medication administration deficiency and plan of correction discussion |
Inspection Report — Oct 8, 2025
Complaint Investigation
Date: Oct 8, 2025
Visit Reason
The inspection visit was conducted to investigate a complaint regarding fall incidents and alleged abuse involving a resident (R1) at the facility.
Complaint Details
The visit was complaint-related under Control # 15-AS-20251007084713. The complaint involved fall incidents and alleged abuse of resident R1. The complaint was substantiated by findings of missing required reports.
Findings
The facility failed to submit required Unusual Incident Reports (UIRs) and the SOC341 form related to the incidents and alleged abuse within the required timeframes. Deficiencies were cited for noncompliance with reporting requirements under Title 22 California Code of Regulations.
Citations (2)
CCR 87211(a)(1) Reporting Requirements: The licensee did not submit a written report to the licensing agency and responsible person within seven days for fall incidents and alleged abuse involving resident R1.
CCR 87211(c) Reporting Requirements: The licensee did not report suspected physical abuse to the local ombudsman, licensing agency, and law enforcement within 24 hours, posing potential safety and personal rights risks to persons in care.
Report Facts
Deficiencies cited: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Haidie Bautista | Administrator | Named in relation to failure to submit Unusual Incident Reports and SOC341 form |
| Alicia Delmundo | Licensing Program Analyst | Conducted the inspection and documented findings |
| Bennett Fong | Licensing Program Manager | Oversaw the licensing program related to this inspection |
Inspection Report — Jul 10, 2025
Complaint Investigation
Date: Jul 10, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff (S1) sexually abused resident (R1).
Complaint Details
The complaint alleged that staff (S1) sexually abused resident (R1) by inappropriate touching and kissing. The resident gave inconsistent statements, and no evidence was found to substantiate the allegation. The complaint was closed as unsubstantiated.
Findings
The investigation found inconsistent statements from the resident and no corroborating witnesses. Staff (S1) denied the allegations, and local law enforcement closed their case due to lack of a statement. The complaint was closed as unsubstantiated with no deficiencies cited.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Haidie Bautista | Administrator | Facility administrator met during investigation |
Inspection Report — Jul 3, 2025
Complaint Investigation
Date: Jul 3, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that due to lack of supervision, a resident eloped from the facility.
Complaint Details
The complaint alleged lack of supervision resulting in a resident eloping. The allegation was unsubstantiated after investigation.
Findings
The investigation found that the staff were providing appropriate supervision for the resident, and the resident's physician report confirmed he was able to leave the facility unassisted. Therefore, the allegation was unsubstantiated due to lack of preponderance of evidence.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| James Sampair | Licensing Program Analyst | Conducted the complaint investigation. |
| Andrew Christy | Licensing Program Analyst | Conducted the complaint investigation. |
| Sally Espina | House Manager | Interviewed during the investigation. |
| Haide Bautista | Administrator | Facility administrator named in report header. |
Inspection Report — Apr 21, 2025
Complaint Investigation
Date: Apr 21, 2025
Visit Reason
The inspection was conducted as a case management health and safety check resulting from a complaint received by the Department.
Complaint Details
The visit was triggered by complaint number 15-AS-20250417163152. No citations or deficiencies were found during the inspection.
Findings
The Licensing Program Analyst toured the facility and observed various areas including kitchens, dining rooms, living rooms, bedrooms, bathrooms, smoking area, and shared yard. No citations were issued during the inspection.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Haide Bautista | Administrator | Met with Licensing Program Analyst during inspection. |
| James Sampair | Licensing Program Analyst | Conducted the inspection and case management health and safety check. |
| Sally Estina | House Manager | Accompanied the Licensing Program Analyst during the facility tour. |
Inspection Report — Mar 25, 2025
Complaint Investigation
Date: Mar 25, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted to examine allegations regarding quality of meals, telephone use restrictions, and leisure time activity restrictions at the facility.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included poor quality meals, restricted telephone use, and restricted leisure activities. Interviews and observations did not support these claims, and no deficiencies were cited.
Findings
The investigation found no substantiated evidence to support the allegations. Staff and residents provided consistent information that meals were varied and adequate, residents were allowed telephone use with courteous time limits, and leisure activities including TV watching were permitted with reasonable controls.
Report Facts
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Haidie Bautista | Administrator | Named in relation to complaint investigation and interviews |
| Alicia Delmundo | Licensing Program Analyst | Conducted the complaint investigation |
| Sally Espina | House Manager | Interviewed during complaint investigation |
Inspection Report — Oct 24, 2024
Annual Inspection
Date: Oct 24, 2024
Visit Reason
The visit was an unannounced annual inspection conducted to evaluate compliance with licensing regulations and facility standards.
Findings
The inspection found several maintenance and record-keeping deficiencies including greasy cooking range, vinyl flooring tiles coming off, mildew and broken faucet in shower, chipped electrical outlet plate, missing medication documentation, and medication labeling issues. Plans of correction were discussed and due by November 7, 2024.
Citations (5)
CCR 87555(b)(27) General Food Service Requirements: The kitchen in Building A had greasy cooking range and grease deposits on the floor, posing a health and safety risk.
CCR 87303(a) Maintenance and Operation: Vinyl flooring tiles were coming off in Building B; mildew and broken faucet were observed in the shower in Building B; and a chipped electrical outlet plate was found in a resident's room in Building A.
CCR 87465(h)(4) Incidental Medical and Dental Care: Staff crossed-out one resident's medication label, which is not allowed and poses health and personal rights risks.
CCR 87506(a) Resident Records: The facility did not have LIC622 medication documentation for a resident's medications filled on 10/02/24 and 10/21/24, posing health and personal rights risks.
CCR 87465(a)(4) Incidental Medical and Dental Care: A resident had a doctor's order for Ferrous Sulfate but the facility did not have this medication, posing an immediate health risk.
Report Facts
Plan of Correction Due Date: Nov 7, 2024
Plan of Correction Due Date: Oct 25, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Haidie Bautista | Administrator | Met with Licensing Program Analyst during inspection and discussed deficiencies and plans of correction. |
| Sally Espina | House Manager | Met with Licensing Program Analyst during inspection. |
Inspection Report — Nov 10, 2023
Annual Inspection
Date: Nov 10, 2023
Visit Reason
The visit was an unannounced annual inspection conducted to evaluate compliance with licensing requirements and regulations.
Findings
The inspection found the facility generally compliant with safety and operational standards, but cited deficiencies related to staff training and medication storage. Plans of correction were discussed with the administrator.
Citations (3)
CCR 87705(f)(2) Care of Persons with Dementia requires certain substances to be stored inaccessible to residents with dementia. Staff medications were found in an unlocked room, posing immediate health and safety risks.
HSC 1569.625(b)(2) requires staff to complete additional annual training including dementia care and postural support. Staff member S3 lacked the required training, posing potential health and safety risks.
CCR 87411(c)(1) requires staff providing care to have first aid training. Staff member S3 did not have first aid training, posing potential health and safety risks.
Report Facts
Deficiencies cited: 3
Inspection Report — Jul 19, 2023
Annual Inspection
Date: Jul 19, 2023
Visit Reason
Unannounced annual inspection conducted to evaluate facility compliance with licensing regulations.
Findings
The inspection found that the facility generally maintained safety and infection control standards, but noted deficiencies related to outdated resident appraisals and dementia care assessments. Updated documents were received during the visit and plans of correction were discussed.
Citations (2)
CCR 87463(c) Reappraisals: Four residents' appraisals are over a year old, posing potential health and personal rights risks.
CCR 8888 87705 Care of Persons with Dementia: Resident R4's LIC602A and reappraisal are over a year old, with discrepancies in ADL dependency noted.
Report Facts
Liability insurance coverage amount: 3000000
Number of residents with outdated appraisals: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Haidie Bautista | Administrator | Met with Licensing Program Analyst during inspection and discussed deficiencies and plans of correction. |
Inspection Report — Jul 11, 2023
Complaint Investigation
Date: Jul 11, 2023
Visit Reason
The visit was conducted to investigate a complaint regarding failure to submit an Unusual Incident Report and lack of Pre-Admission Appraisals and Re-appraisals for certain residents.
Complaint Details
The complaint investigation found substantiated deficiencies related to failure to submit an Unusual Incident Report for a resident who went AWOL and failure to complete required Pre-Admission Appraisals and Reappraisals for residents.
Findings
The facility failed to submit an Unusual Incident Report when a resident went AWOL, and did not complete Pre-Admission Appraisals or Re-appraisals for two residents. These deficiencies were cited under Title 22 California Code of Regulations.
Citations (3)
CCR 87211(a)(1) Reporting Requirements: The licensee did not submit a written report to the licensing agency within seven days of a resident going AWOL.
CCR 87457(c) Pre-Admission Appraisal: The licensee did not complete Pre-Admission Appraisals for two residents prior to admission.
CCR 87463(b) Reappraisals: The licensee did not bring changes in residents' behaviors to the attention of their physician and family as required.
Report Facts
Plan of Correction Due Date: Jul 25, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Haidie Bautista | Administrator | Named in relation to failure to submit incident report and incomplete appraisals |
Inspection Report — Nov 4, 2022
Original Licensing
Date: Nov 4, 2022
Visit Reason
Pre-licensing inspection conducted for a license application to change facility type to Residential Care Facility for Elderly (RCFE) and to grant a license for 42 total capacity.
Findings
The facility was inspected for compliance with licensing requirements including safety, hygiene, and infection control. Several deficiencies were noted such as lack of auditory alarms, no signal system or call buttons for residents, hot water temperature measured at 122°F, beds initially lacking mattress pads, and missing posted signage which were corrected during the inspection.
Citations (6)
No auditory alarms on all entrance and exit doors were observed.
No signal system on both buildings and no call buttons for residents' use were present.
Hot water temperature was measured at 122 degrees Fahrenheit in one common bathroom.
Beds had no mattress pads initially; staff placed mattress pads on beds during inspection.
No "Wear Masks" posters in common areas, dining room, and activity room; applicant posted posters during inspection.
Facility's Theft and Loss Policy was not posted; applicant posted the document during inspection.
Report Facts
Liability insurance amount: 3000000
Fire extinguisher service date: Feb 2, 2022
Hot water temperature: 122
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Haidie Bautista | Applicant-administrator | Met with Licensing Program Analyst during inspection and authorized staff to accompany LPA |
| Alicia Delmundo | Licensing Program Analyst | Conducted the pre-licensing inspection |
Inspection Report — Nov 4, 2022
Date: Nov 4, 2022
Visit Reason
The visit was a Case Management - Other type, involving Component III Training conducted via Teams Meeting with the applicant-administrator.
Findings
Licensing Program Analyst Delmundo conducted Component III Training via Teams Meeting, which was attended by the applicant-administrator Haidie Bautista. A PowerPoint presentation and discussion were held, followed by an exit interview and provision of the report copy.
Inspection Report — Oct 17, 2022
Date: Oct 17, 2022
Visit Reason
The visit was an office evaluation conducted via telephone call to complete Component II (COMP II) of the licensing process, verifying the applicant/administrator's understanding of Title 22 and related regulatory requirements.
Findings
The applicant/administrator successfully completed COMP II, demonstrating understanding of facility operation, staff qualifications, program policies, grievance procedures, physical plant, and application documentation requirements. No deficiencies or violations were noted in the report.
Report — March 11, 2026
March 11, 2026
Report — March 11, 2026
March 11, 2026
Report — March 11, 2026
March 11, 2026
Report — December 19, 2025
December 19, 2025
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