Complaint Investigation Report

415601140-11-14-2024-14-AS-AMEN-DCYPKM-20250116102318

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SAN BRUNO RO , 851 TRAEGER AVE., SUITE 360

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

08/01/2024 and conducted by Evaluator John Calandra

COMPLAINT CONTROL NUMBER: 14-AS-20240801084531

Facility staff did not properly address pest infestation.

Facility staff did not ensure timely medical attention resulting in injury.

On November 14, 2024, Licensing Program Analyst (LPA) John Calandra arrived at the facility to conclude a complaint investigation. Initial complaint was conducted on 10/23/2024. On previous visit on 10/23/2024, LPA interviewed residents and staff. Also, LPA requested documents during last visit and those have been reviewed. LPA Calandra was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit.

Regarding the allegation that facility staff did not properly address a pest infestation in the facility, LPA interviewed staff and collected documents. Based on record review, it was found that the facility’s pest control company was providing bed bug mitigation services indicating that the facility had a bed bug infestation from 3/1/2024 to 8/1/2024 which led to a resident being sent to the hospital for the worst case of bed bugs.

Regarding the allegation that facility staff did not ensure timely medical attention resulting in injury, LPA interviewed staff and Executive Director. Based upon interview of Executive Director, it was found that (R2) had been found in R2’s room with R2’s head bleeding. Facility staff provided first aid care and then waited for the Executive Director to come to the facility before calling 911. While being transported to the hospital R2 reported being attacked by R2’s roommate.

A finding that the complaint is SUBSTANTIATED means that the allegations are valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal rights provided.