Senior Care Records.

Complaint Investigation Report

Vila Victoria #1, San Jose04/03/2024Licence 435202473

Census21
Date signed04/03/2024 07:06:12 PM
The inspector’s account

435202473-4-3-2024-26-AS-JJIN-D6ZV2U-20240709160344

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

07/09/2021 and conducted by Evaluator Grace Donato

COMPLAINT CONTROL NUMBER: 26-AS-20210709140612

On 4/3/2024, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint inspection. LPA met with Administrator Cyril Inneh and explained the purpose of the visit.

The Department investigated the allegations that facility does not have hot water and has bed bugs and based on observation and interviews, the allegations are substantiated. During the tour of facility bathrooms, the water temperature at the sinks and showers tested at 75 degrees Fahrenheit, and interviews of residents and staff indicate that the facility has bed bugs. No documentation was observed to indicate facility had recent pest control services to eradicate the bed bugs.

Therefore, based on interviews and records review and information collected, the above allegations are

determined to be SUBSTANTIATED. Deficiencies of the California Code of Regulations, Title, 22

cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties.

A copy of this report and the Appeal Rights are provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction