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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191592599
Report Date: 07/06/2021
Date Signed: 07/06/2021 04:30:15 PM

Document Has Been Signed on 07/06/2021 04:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:FOUNDERS HOUSE OF HOPEFACILITY NUMBER:
191592599
ADMINISTRATOR:YNA BARNESFACILITY TYPE:
735
ADDRESS:18025 PIONEER AVE.TELEPHONE:
(562) 860-3351
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 98CENSUS: 78DATE:
07/06/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:48 PM
MET WITH:Dana Ordonez, Assistant Administrator TIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Galarza and Spencer conducted a Case Management -Deficiencies visit due to observations made during complaint control #: 28-AS-20210623153840 visit. LPA met with Assistant Administrator Dana Ordonez and explained the purpose of the visit.

On 5/14/2021, the facility faxed an incident report stating bed bugs were found in rooms 4, 28, 40, 41, 42, 43, 45, 48. Pest Control company conducted a site visit on 5/14/2021 to evaluate the problem. Treatment was completed on 5/18/2021 & 5/19/2021. On 5/17/2021, LA County Department of Public Health conducted a site visit and found bed bugs and observed facility staff heat treat room 4, 28, and 6 other rooms.

During today's visit staff and residents were interviewed. Interviews revealed there are still bed bugs in the facility. LPAs observed two bed bugs while conducting interviews in the rear outdoor area.

Facility contracted a new pest control company on July 2, 2021 that will begin treatment of bed bugs, cockroaches, and general pests today 7/6/2021.

The following were observed/inspected:
  • At 11:26 am the rear parking lot area and designated smoking area were observed. A total of 3 discarded mattresses were observed behind a storage bin. Assistant Administrator confirmed the mattresses were discarded due to bed bug infestation.

  • Two (2) residents reported observing cockroaches in the kitchen and dining room areas.


Deficiencies are cited in LIC 809D.

Exit interview conducted with Assistant Administrator Dana Ordonez. Appeal Rights were issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/06/2021 04:30 PM - It Cannot Be Edited


Created By: Noemi Galarza On 07/06/2021 at 03:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: FOUNDERS HOUSE OF HOPE
FACILITY NUMBER: 191592599

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2021
Section Cited
CCR
80087(a)(1)

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80087(a)(1) Buildings and Grounds
The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. The licensee shall take measures to keep the facility free of flies and other insects.

This requirement was not met by evidence of:
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Licensee shall contract a Pest Control company to re-evaluate and treat the entire facility. All rooms shall be checked and treated for bed bugs. In addition, cockroach and other bug infestation must also be traeted.
1. Submit proof of completed Pest Control work order. 2. Submit proof that discarded mattresses have been removed 3.Provide a written plan and pest control recommendations by POC due date.
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Based on observations, interviews and record review the licensee has not taken necessary measures to treat the bed bug infestation reported on 5/14/2021. During today's visit, LPAs observed 2 bed bugs. Staff and resident interviews confirmed there are still bed bugs in the facility. This poses and immediate health and safety risk.
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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:Lisa Hicks
LICENSING EVALUATOR NAME:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2021


LIC809 (FAS) - (06/04)
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