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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 371881545
Report Date: 09/03/2026
Date Signed: 09/03/2026 02:42:55 PM

Substantiated


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
08/28/2026 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20260828094442
FACILITY NAME:BELLEVUE VILLAFACILITY NUMBER:
371881545
ADMINISTRATOR:DIZON, CAROLINAFACILITY TYPE:
740
ADDRESS:2080 HEIGHTS COURTTELEPHONE:
(760) 518-8508
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:6CENSUS: 10DATE:
09/03/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Carolina DizonTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Licensee did not maintain a comfortable temperature in the facility
INVESTIGATION FINDINGS:
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On 9/3/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of launching the complaint investigation. LPA Flores met with "staff" Daniel Rodriguez and explained the purpose of the visit.

On 8/28/2026, Community Care Licensing (CCL) received information alleging Licensee did not maintain a comfortable temperature for Resident #1 (R1). Upon LPA Flores’ arrival, LPA observed fans running in common areas of the facility. The thermostat was observed to be out-of-service. Interview with Staff #1 (S1) reports that the central air conditioning was not working but the Licensee has implemented window-mounted air conditioning units in select resident bedrooms. LPA toured all resident bedrooms and observed that there was no window-mounted air conditioning in Bedroom C and E. Although there were fans running in residents bedrooms with no air conditioning, the overall temperature of the room was warm.

(Continue to LIC9099)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
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 3
Control Number 18-AS-20260828094442
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: BELLEVUE VILLA
FACILITY NUMBER: 371881545
VISIT DATE: 09/03/2026
NARRATIVE
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(Continuation from LIC9099)

Therefore, the allegation of Licensee did not maintain a comfortable temperature in the facility is deemed substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid the as preponderance of the evidence standard has been met. California Code of Regulations Title 22 is being cited on the attached LIC9099D.

An exit interview was conducted, and a copy of the LIC9099, LIC9099C, LIC 9099D, and appeal rights were reviewed and provided to the Licensee.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20260828094442
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: BELLEVUE VILLA
FACILITY NUMBER: 371881545
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2026
Section Cited
CCR
87303(b)
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(b) A comfortable temperature for residents shall be maintained at all times.: This requirement was not met with evidence by: R1's bedroom was observed to be warm as the central air conditioning was in disrepair.
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Licensee reports that they will be purchasing and installing an window-mounted air conditioning unit for Bedrooms C and E. In the meantime, Licensee will ensure there are fans running and proper circulation in both bedrooms. Proof of purchase and a photo of installation will be submitted to LPA by
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Close of Business (COB) on 9/17/2026.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3