Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management visit and met with Co-Licensee Tiffany Dizon to follow up on a self-incident report received on 5/19/26.

Per incident report, on 5/13/26 resident (R1) complained of pain in their right shoulder and needed to go to the emergency room, staff called 911 immediately to transport R1 to the hospital for further evaluation. Responsible parties were notified. Based on after summary visit records, R1 was discharged back to the facility same day with a diagnosis of rash, bedbug bite, and axillary abscess. Instructions provided to R1 included an examination of R1’s bedding to take proper measurements to get rid of them and states that they didn't find any bedbug on R1's body. During today’s visit, LPA made observations, conducted interviews and reviewed documents. Based on records review, R1's physician report dated 9/11/25 indicates that R1 is capable for self-care, but the facility is responsible for laundry services of residents' beddings, R1 also has a roommate resident (R2). The facility provided room treatment log revealing that the last room treated was #11, 5 and 12 located in Wing A back on 3/4/26. Based on interviews conducted with Administrative Assistant and staff (S1) who performs the treatments, after they learned about R1's diagnosis, they went to R1's room to check and they didn't find any bedbugs, so they didn't threat the room. On 4/4/25, Licensing staff held an informal meeting with facility representatives and LPA have cited the facility to address ongoing bed bugs issues and other unrelated areas of concern, where Co- Licensees contracted a pest control vendor to provide their services to help to get rid of bed bugs at the facility to ensure resident’s health and safety. However, based on interviews and records review of after summary visits revealed that the facility still has bedbugs issues unresolved and the facility did not treated R1's room after learning of bedbugs. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. ***Civil penalties in the amount of $250 issued for repeated violation. Exit interview was conducted with Co-Licensee and a copy of this report was given.