Complaint Investigation Report

197606562-11-15-2021-31-AS-EMIR-C9CQ86-20211203105612

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD., STE. 250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

11/09/2021 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20211109163557

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit.

It is alleged that the facility is not clean and has had an issue with rodents. LPA conducted a physical plant walk through of the facility approximately 9:50am-10:15am. During the physical plant walk through LPA did observe some clutter in the living room area. LPA observed the kitchen to be cluttered with a lot of debris that needed to be cleaned up. During the walkt through LPA observed some roaches in the kitchen area. LPA conducted an interview with the administrator who admitted that there has been an issue with roaches and that she has had a pest control company come to service the facility. Based on the information obtained through interviews and observation this allegation is deemed Substantiated. Deficiency cited on LIC 9099 D. Appeal Rights explained. Exit Interview conducted.